27 Jun 2014

Insulin use - Practical points

Diabetes mellitus is a progressive, metabolic disorder where there are disturbances in carbohydrate, lipid and protein metabolism. It results from insulin deficiency and / or insulin resistance. As the global burden of diabetes is increasing number of patients on insulin also increases. All those who are on insulin must know the following practical points.
Storage of insulin
  1. Stored in a cool and dark place, otherwise their potency is lost (Temperature dependent).
  2. Do not keep in a freezer compartment. 
  3. The vial in current use can be easily kept at room temperature in a dark place without losing any potency. 
  4. Cold insulin if injected is painful.

Insulin injection sites
  • Absorption of insulin shows regional difference
    Absorption of insulin is maximum from abdominal region followed by upper outer arms, buttocks and upper outer thighs.
  • Abdominal region > upper outer arm and buttocks > upper outer thighs
  • The site of injection should be rotated within the same area.
  • Depth of injection – subcutaneous with insulin syringe.
  • Intravenous injection (direct injection into vein), Intravenous infusion , or Intramuscular routes (direct injection into muscle ) are used only during, emergency such as  ketoacidosis or stressful conditions.
  • Same site is used for at least one month and rotation is done within the same site rather than rotating to different sites.
  • Using same site decreases variability in day to day absorption. 
  • Rotation within the same area prevents lipodystrophy.
  • Avoid a site with open wounds or blisters.

Injection technique
  • If site is clean, there is no need to clean the site with alcohol or spirit. 
  • In thin or averagely built person, lift or grasp a fold of skin between thumb and index finger and inject at 45° or 90°.
  • In obese person, full length injection at 90° is recommended.
  • Mixing – usually available as premixed form.
  • Regular insulin can be mixed with all other preparations.
  • Insulin glargine should not be mixed with other insulin.

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