Insulin Administration and Diabetes

Insulin is a hormone secreted by the pancreas – an organ which apart from producing juices that help in digestion of food , also produces certain hormones which have wide ranging effects on body metabolism.

While it has other effects, insulin’s principal effect is uptake of glucose by the cells of the body and is mostly released by the pancreas in response to increased blood glucose.

In conditions like Diabetes Mellitus (DM) there is decreased/absent insulin production ( type 1 ) or decreased sensitivity of cells to glucose (type 2 ) , resulting in elevated blood glucose levels that have deleterious effects on the body.

Insulin therefore is prescribed to people with type 1 DM or sometimes in people with type 2 when medication alone doesn’t provide satisfactory results.

Insulin is always administered as an injection. It cannot be taken orally because it is a peptide hormone – and peptides get digested in the digestive tract.
Being a huge potential market, several efforts are underway to develop an orally administered form of insulin. Intra nasal insulin is also under study. Such options would go a long way in improving diabetes management.

Insulin is injected into the subcutaneous layer of the skin. There are various sites on the body where it can be administered this way. These will be described subsequently. Methods include using syringes for each dose or an insulin pump which administers doses throughout the day.

How to administer insulin

It is imperative if you’re injecting for the first time , that you learn this from your health care provider. The following steps are only a rough guide and not a substitute.

1.Get everything needed – insulin vials, syringes, spirit swabs
2.Check insulin vial. A newly opened vial should not be used more than a month as the insulin would have undergone degradation by then.
3.Wash hands with soap and water.
4.Mix the insulin in the vial gently.
5.Use a spirit swab to clean to top of the insulin vial. Let it dry.
6.Remove the protective sheath of the insulin syringe – withdraw plunger till the required dose is set. Do not touch the needle at any point during the whole process.
7.Insert the needle of the syringe into the rubber cap of the insulin vial. Inject the air inside the syringe into the vial by pressing on the plunger.
8.Turn the vial upside down and withdraw plunger slowly till the amount of insulin in the syringe is slightly more than the required dose.
9.Remove the syringe from the vial.
10.Hold syringe with needle facing upwards. Tap gently so that air bubbles if any will rise up. Push the plunger slowly till all the air bubbles are expelled and a little insulin comes out through the needle.
11.Identify the site where you want to inject and clean with a spirit swab – wait till the skin dries.
12.Hold the skin between forefinger and thumb gently raising a fold of skin.
13.With the other hand , take the syringe and enter the fold of skin with the needle at 90 degrees to the surface. With experience you will get to know how deep to enter.
14.Depress the plunger fully so that all the insulin is injected.
15.Withdraw the syringe at the same angle.
16.If there is slight bleeding, apply pressure with the spirit swab. Do not rub the area.
17.Dispose of the needle carefully. You could have a plastic container where you can dispose the syringes. Do not attempt to resheath the needle after using. These could be regularly disposed of at the hospital or lab.
18.Do not reuse used syringes. Apart from sterile concerns, a used needle undergoes blunting and wearing away of its protective covering – therefore entering the skin with it causes more trauma and damage to the tissue.
19.Keep the insulin vial back in the refrigerator.
20.Keep the other supplies in their designated areas.

Insulin is injected into the subcutaneous tissue just under the skin.
Areas on the body where people can inject insulin most easily are:

1.the abdomen, except the area around the navel
2.he upper and outer areas of the arms
3.the front and the outside of the thighs
4.the area just above the waist on the back
5.the buttocks

If insulin needs to be administered three or more times a day then it’s wise to rotate injection sites. Injecting in the same place much of the time can cause hard lumps or extra fat deposits to develop. Apart from being unsightly; they can also change the way insulin is absorbed, making it more difficult to keep your blood glucose within control.

Insulin is absorbed at different speeds depending on where you inject, so it’s best to consistently use the same part of the body for each of your daily injections. For eg. if the abdomen has been used for the morning injections it is best to use the abdomen always for the morning doses, and to change this pattern every 2 weeks.
Tissues wise insulin absorption rates vary
21.Fastest from the abdomen (stomach)
22.Then from the arms
23.Followed by the legs
24.Slowest from the buttocks
Unless advised otherwise, it is a good idea to inject breakfast and lunch bolus doses into the abdomen. Insulin is absorbed fastest when injected into this area. Fast absorption is needed at mealtimes to cover the carbohydrates..
Dinner or bedtime dose of long-acting insulin could be injected into the thigh, buttocks, or upper arm. That’s because the long-acting insulin should take effect gradually and control glucose throughout the night.

Other tips

Monitor blood glucose levels carefully while injecting insulin. Over time, it will be apparent which injection sites give you the best blood glucose control at different times of day.

Do not inject close to the belly button, moles or scars. The tissue there is tougher, so the insulin absorption will not be as consistent.

If you inject in the upper arm, use only the outer back area (where the most fat is). It is hard to pinch the upper arm when you are injecting yourself.

If you inject in the thigh, stay away from the inner thighs. If your thighs rub together when you walk, if might make the injection site sore.

Do not inject in an area that will be exercised soon. Exercising increases blood flow, which causes long-acting insulin to be absorbed at a rate that’s faster than you need.

It might seem easier to find a spot that does not hurt and inject there all of the time. However, the result could be unpleasant swelling and lumps.

You can reduce injection pain by choosing a needle length and gauge that are right for you.
Move to a new injection site every week or two.

Inject in the same area of the body, making sure to move around within that area with each injection, for one or two weeks.

Then move to another area of your body and repeat the process.

Use the same area for at least a week to avoid extreme blood sugar variations.

Rotate the sides (right, left) of your body where you inject within your injection sites.

Harmony Between Food Intake and Insulin Is Essential For The Person With Type 1 Diabetes Mellitus

Type 1 Diabetes Mellitus features insulin deficiency or insulin lack resulting from immune attack upon the insulin-producing Islet Cells in one’s pancreas. Elevated blood glucose results.

Therapy for Type 1 Diabetes Mellitus requires prescription insulin which is typically injected daily as replacement of the missing pancreas supplied insulin.

Prescription insulin comes in various forms and strengths, and one’s physician or advanced practice nurse will determine the right form and right dose.

Many individuals with Type 1 Diabetes are receiving prescribed insulin by means of a continuous infusion insulin pump. A small infusion needle is placed securely just beneath the skin in a safe location and insulin is steadily infused into the tissues just beneath the skin where it is steadily absorbed. The amount of insulin infused is determined by the ordering diabetes specialist and this amount is determined to fit one’s basal metabolism. This infusion is called a “basal” infusion of insulin and this imitates a normal pancreas. These insulin infusion pumps also provide a “bolus” infusion of the same insulin on command. The diabetic person is taught to “bolus infuse” a determined amount of insulin to match the person’s diet content of carbohydrates. This also intends to imitate the normal pancreas which would secrete a bolus of insulin in response to a glucose surge in the blood stream, derived from a meal or beverage. The “bolus” of insulin delivered by the pump occurs when the diabetic person pushes a button. Hence, one can see the vital importance of harmony and timing: the bolus amount of insulin must match the amount of carbohydrate eaten and must be infused at the same time as the meal or snack is consumed. Insulin infusion pumps do serve very well, and the basal-bolus infusion methods can imitate the normal pancreas, if the pump is programmed in a fitting pattern to the diabetic person’s pattern of meals and snacks and body size and activity. A potential benefit is that the pump can be adjusted as the diabetic person alters his or her patterns. However, too much variation hour to hour and day after day will result in poor glucose control. Type 1 Diabetes Mellitus is brittle. Blood glucose can rapidly rise or fall when insulin infusion and carbohydrate ingestion do not harmonize. This can be dangerous.

Many other individuals with Type 1 Diabetes Mellitus are prescribed insulin by single injection into the subcutaneous tissues, typically at the abdominal wall or top of the thigh. Two insulin types are prescribed – long acting basal insulin and short acting bolus insulin – and the intent is to create a pattern that will harmonize with meals, activity, and sleep. The diabetic person will inject the long acting basal insulin once a day, and this insulin will slowly be absorbed from the injection deposit under the skin. Current long acting basal insulin preparations are absorbed steadily over approximately 24 hours and this provides the basal, background, continuous presence of insulin, again imitating a normal pancreas’ basal secretion of insulin. Current short acting bolus insulins are absorbed rapidly from the injection site and are thus suitable for covering one’s meal provision of glucose. The diabetic person is instructed to inject the short acting bolus insulin immediately prior to a meal and the amount of insulin injected is prescribed to match the carbohydrate content of the meal. Type 1 Diabetes Mellitus is brittle. Blood glucose can rapidly rise or fall when insulin injections and carbohydrate ingestion do not harmonize, and these swings can be harmful. Again, the vital importance of timing and harmony with meal content is real.

So, the vital message here is this: tight yet safe glucose control with either infused or injected insulin is vitally important for health maintenance of the Type 1 Diabetic person. The goal for one’s fasting blood glucose is approximately 80-120 mg/dL and the goal for one’s pre-meal blood glucose is approximately 100-140 mg/dL. Optimal management of the blood glucose also includes maintaining the blood glucose less than 140 mg/dL during the 1-3 hour time frame after eating as well. Achieving these goals is possible, but achieving these goals commands insulin dosing that is precisely timed with meals, precisely quantified to match the carbohydrate content of the meal or snack, and thus precisely delivered. Consistency is essential. Having a pattern of regularity is essential. Knowing carbohydrate content of foods is essential. And being consistent with quantity and type of food and beverage is essential, so that harmony and synchrony is achieved morning, noon, evening, and night.