Taking Your Insulin
When insulin was discovered in 1921 it was literally a life-saver for those with type 1 diabetes. Prior to this, deaths due to diabetic coma were unavoidable. Insulin treatment has come a long way from the early days when insulin was extracted from animal pancreas from pigs and cows. Insulin today is manufactured in laboratories - though animal derived insulins are still available but are not that widely used. It is now also much easier and less painful to give an insulin injection as there are now a whole range of insulin pens and other delivery devices available. Unfortunately insulin must still be given as an injection but work continues to find other ways of taking it.
Why are there so many different types of insulin available?
There are lots of different types of insulin available. This is to give flexibility and choice because everyones needs are different. Talk to your doctor or nurse if you have questions about your particular insulin therapy. Some insulins are fast-acting insulins which are quickly absorbed when injected and tend to last no more than a few hours after injection. These insulins are generally taken with meals and stop your blood sugars rising too high after a meal. Then there are longer acting insulins like Lantus and Levemir which are only slowly absorbed from the injection site. This makes their duration of action much longer. These preparations are generally taken at bed time so that the effect lasts overnight and well into the next day. These insulins are called basal insulins. Then there are mixtures of different short and longer acting insulins which are taken twice daily at breakfast and teatime. Mixtures such as Human Mixtard 30 or NovoMix 30 are mixtures of long and short acting insulins which are combined together for convenience. It used to be that you had to mix your own insulins in a syringe.
What is it like to start on insulin?
Dont panic it is not as bad as it sounds. If you are already doing finger prick blood tests that is worse! Nowadays insulin is usually given using a convenient and easy to use pen device. There are a number of pens available.Your diabetes nurse will help you choose the one most suitable for you. On the whole injecting insulin is relatively painless. The needles used for injecting are very fine and short. You should change your needle after each injection. Your doctor or diabetes nurse will guide you as to how many times you need to inject each day. Once daily long acting insulin can be taken along with oral hypoglycaemic tablets. Insulin mixtures are taken twice a day, usually with breakfast and with your evening meal. Basal Bolus insulin is taken four times a day, using a quick acting insulin with each meal and a basal insulin taken once a day (usually at bedtime) to give a steady level of background or basal insulin. When you start on insulin you will also spend time with your dietitian as you need to continue to eat a healthy diet having regular meals, remembering to include a portion of starchy carbohydrate containing food at each meal. You may also be advised to have a small snack between meals. You must also inform the DVLNI and your car insurance company that your treatment for diabetes has changed and is now insulin. Unfortunately you will not be able to continue to hold an HGV licence when you are on insulin. Your diabetes nurse will also teach you how to avoid, recognise and deal with hypos.
How do I inject myself with insulin?
Insulin is injected into the layer of fat that lies just beneath the skin using a pen injector or a needle and syringe. Using modern day ultra fine needles means it is relatively painless. You can inject in various spots the front or outer aspect of both thighs, the upper outer area of your buttocks, the skin over the tummy below the belly button and into the outer and rear surfaces of both upper arms. It is important not to use the same site all the time. Use different sites. If you use the same area, aim to move the site of injection about and around the area. Remember that insulin tends to be absorbed more quickly from the tummy and upper arms and more slowly from the thighs and buttocks. You can use this to your advantage such as by giving your morning injection into your tummy and the evening dose in your thigh. It is not necessary to use alcohol wipes or any other cleanser to clean the skin it just makes the injection sting! Just make sure your hands have been washed with soap and water and that the area of injection is reasonably clean. Thin built people with little fat should lift up a fold of skin and inject the insulin into it. If you have a plentiful layer of fat, stretch the skin slightly before injecting. Place the needle against a bit of skin that is a decent distance from the last injection. Avoid superficial veins that you can see dont worry about the ones that you cant ! Position the pen or syringe at right angles to the skin and insert the needle up to its full depth before injecting. Don't inject too quickly or press too hard on the plunger. Press down on the plunger and allow a few seconds for the dose to be delivered before withdrawing the needle. This reduces the chance of insulin leaking out. Massage the area gently. Don't be surprised if a droplet of blood or insulin comes out with the needle. This is quite normal. Place the used needle in your sharps container. To keep the injection as painless as possible enter the skin quickly, do not move the needle around or change direction once inserted, avoid re-using disposable needles and ensure your insulin is at room temperature and not just taken from the fridge.
How do I look after my insulin?
Insulin is a protein and when proteins are heated they tend to get damaged. So if your insulin overheats it will lose its effectiveness. For this reason it is recommended that insulin is kept in the fridge (not the freezer!) whenever possible. However, insulin may be left at room temperature for up to a month as long as it is kept away from direct sunlight or heat. If your insulin has been left out of the fridge for longer than 4 weeks dont use it - it should be discarded. Always check how your insulin looks before using it. If it looks funny or different then don't use it! Check the expiry date to see it is OK. Once you start to use a pen or vial of insulin discard it after 4 weeks if it is not used up and start with a fresh supply.