1. To be injected subcutaneously

Insulin injections are subcutaneous, to inject insulin into the subcutaneous tissue, to avoid injecting into the muscle layer, which affects the efficacy of the treatment.

 

2. To choose the right injection site

Common body injection sites are suitable for insulin injections based on the condition of blood vessels, nerves, subcutaneous tissue, and whether or not the site is convenient for injection:

 

(1) Abdomen:

For the abdominal injection site, the upper end is not higher than 1cm below the lowest rib margin, the lower end is not lower than 1cm below the pubic symphysis, and the middle avoids the area within a diameter of 5cm (as well as a radius of 2.5cm) centered on the belly button.

 

However, injections should be avoided within a circular area centered on the umbilicus with a radius of 1 cm. The closer to the sides of the abdominal wall (even in obese patients), the thinner the thickness of the subcutaneous tissues will be, thus easily leading to intramuscular injections, and in order to prevent injections into the muscular tissues, thin patients can pinch up the skin for injection.

 

(2) The middle 1/3 of the lateral aspect of the upper arm:

Dividing the upper arm equally into three segments from the crest of the shoulder to the elbow, it is appropriate to inject in the lateral or posterior aspect of the mid-upper arm. Patients who are thin at the lower edge of the upper arm deltoid muscle should avoid injecting into the deltoid muscle. Injections on the medial side are prohibited; the medial side is rich in blood vessels and nerves, is painful, and is prone to infection.

 

(3) Upper 1/3 of the anterolateral thighs bilaterally:

The subcutaneous tissue here is thicker and it is relatively safe as it avoids the knee joint and is farther away from the sciatic nerve and large blood vessels. Obese patients can also be injected in the middle 1/3 of the anterolateral thigh. It is forbidden to inject in the inner thigh, there have been patients who had a painful experience of large-scale infection and pus, and incision and drainage due to injection in the inner thigh.

 

(4) Bilateral upper outer buttocks:

The subcutaneous tissue is thicker in the buttocks, and even in emaciated patients or lesser children, the subcutaneous tissue is more abundant here, so the risk of injecting into the muscle layer is lowest.

 

Changing the injection site each time

Repeatedly injecting insulin at the same site will result in the proliferation of subcutaneous tissue and the formation of hard knots. If insulin is inadvertently injected into a hard knot, it will reduce the absorption rate of insulin, leading to prolonged absorption of insulin, poor glycemic control, and blood glucose fluctuations.

Therefore, from the time you start injecting insulin, it is important to develop the habit of rotating the injection sites to prevent the formation of subcutaneous tissue hyperplasia or hard knots. Injection rotation includes rotation between different injection sites and rotation within the same injection site.

The abdominal injection site can be divided into four aliquots, and the thighs or police can be divided into two aliquots, with one aliquot used each week and always rotated in a clockwise direction. However, two injections in close proximity should be separated by at least 1 cm, regardless of the aliquot area in which they are injected.

3. The following techniques should also be observed during specific operations

(1) Check the injection site before each injection.

As the same site repeatedly injected or do not change the needle and other reasons, leading to subcutaneous long-term injection of insulin patients, due to improper operation of tissue proliferation, easy to form hard knots. Once insulin is injected into the site with hard knots, it will affect the absorption of insulin and reduce the therapeutic effect.

Therefore, before each injection, you must touch the insulin injection site, avoiding areas with scarring, hard knots, and pain when touching. Once the injection site is found to have pain, redness, swelling, ulcers, indentation of hard knots, bulging, hyperplasia, atrophy and other phenomena, we should stop injecting in the site immediately and find out the reasons in time, and deal with them appropriately if necessary.

(2) Mixing of insulin

NPH and premixed insulin are cloudy suspensions, which should be shaken and mixed before injection. Insufficient mixing will easily cause unstable concentration of insulin injection, resulting in unstable absorption, which is not conducive to the smooth control of blood glucose. Roll the insulin cartridge horizontally with both hands 10 times within 5 seconds at room temperature, and then flip it up and down 10 times within 10 seconds. Flipping refers to turning the injection pen or refill up and down fully upside down, and rolling refers to horizontal rotation between the palms of the hands.

(3) Before each injection, determine the needle length

The general adult skin thickness is 1.25-3.25mm, with an average thickness of 2mm, and the length of insulin needles currently in use are 4mm, 5mm, 6mm and 8mm. When using 4mm or 5mm needles, most patients do not need to pinch the skin and can enter the needle at 90 degrees. When using longer needles (>6mm), which may reach the muscle layer, the skin should be pinched up for injection or the needle should be inserted at 45 degrees. When pinching up the skin, attention should be paid to lifting up the skin at the injection site with the thumb, index finger and ring finger, and it should not be grasped in a big way, so as not to grasp up the muscle at the same time. Therefore, it is recommended to use 4mm~5mm needles when choosing needles for sugar patients to avoid adverse reactions such as hypoglycemia caused by needles piercing through the fat layer and entering the muscle layer during injection. Be careful to pinch the skin and not to pinch up the muscle as well.

(4) Exhaustion before injection

Air should be exhausted from the cartridge before use and after replacement. Exhaustion steps:Before injection, set the dose adjustment knob to 2 units, the needle tip upward and upright, the finger flick the quill frame several times, so that the air gathered in the upper part, press the injection button until a drop of insulin overflowed from the needle, that is to say, the piston rod has been in complete contact with the quill and the air bubbles inside the quill have been exhausted, if not exhausting the quill will lead to less injection of insulin of 2-4 units, which will affect the effect of glucose drop.

(5) Leave the needle for a short time after each injection, and do not rub the injection site.

After fully pressing the thumb button for injection with an insulin pen, the needle should be left in place for at least 10 seconds before removing the needle, and for larger doses of insulin, it is necessary to leave the needle in place for more than 10 seconds. The injection should follow the following key points: enter the needle quickly, inject slowly, leave the needle in place for 10 seconds, and then remove the needle. If the needle is left in for too short a period of time, the liquid will flow out along the eye of the needle after the needle is withdrawn, which will affect the effect of lowering glucose. Do not press the injection site with a dry swab, so that the needle is not too short, and the action and reaction forces will cause the injected insulin to be partially absorbed by the dry swab, resulting in insufficient injection of insulin dose.

Do not rub the injection site repeatedly to avoid accelerating local blood circulation, resulting in rapid absorption of insulin and hypoglycemia.

(6) Seek professional assessment at least once a year

At least once a year, find a nurse specialized in diabetes to assess whether the rotation of injection sites is correct and whether there are any improper injections to be corrected.

The last thing you need to pay attention to is that needles should be replaced in a timely manner, single-use, multiple-use needles tip will be forked, easy to clog or painful, once broken in the body will be more than worth it. Needle discarded recommended to cover the cap, to prevent stabbing others and the risk of infection.

(7) Storage of Insulin

Insulin stability is susceptible to various factors such as temperature, light conditions and vibration.

The information is from the Internet and is for reference only.