Giving a Mixed-Dose Insulin Shot: Care Instructions
Insulin is normally made by the pancreas, a gland behind the stomach. In people with diabetes, the pancreas no longer makes enough insulin or it stops making it. Without insulin, your blood sugar level rises to dangerous levels. When this happens, you need insulin shots to keep your blood sugar in your target range.
You may be nervous giving a shot at first. But soon, giving yourself a shot will become routine. It is quite easy to learn how to draw up insulin into a syringe and give the shot. The needles you use to give the insulin injections are very thin, and most people who have diabetes say that they do not even feel the needle enter the skin. Even if you do feel the injection, the sting of the shot is not bad and does not last long.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
How can you care for yourself at home?
- Gather your supplies. You will need an insulin syringe, your bottles of insulin, and an alcohol wipe or a cotton ball dipped in alcohol. Make sure the types of insulin you're using can be mixed together. Keep your supplies in a bag or kit so you can carry the supplies wherever you go.
- Check the labels on the bottles and contents. Read and follow all instructions on the label, including how to store the insulin and how long the insulin will last.
- Wash your hands with soap and running water. Dry them well.
Preparing the shot
For a mixed-dose insulin shot:
- Roll the insulin bottles gently between your hands. This will warm the insulin if you have kept the bottle in the refrigerator. Roll the cloudy insulin bottle until the white powder has dissolved and the insulin is mixed.
- Wipe the rubber lid of both insulin bottles with an alcohol wipe or a cotton ball dipped in alcohol. (If you are using a bottle for the first time, remove the protective cover over the rubber lid.) Let the top dry before you remove any insulin.
- Remove the plastic cap from the needle on your insulin syringe. Take care not to touch the needle.
- Pull the plunger back on your insulin syringe, and draw air into the syringe equal to the number of units of cloudy insulin to be given.
- Push the needle of the syringe into the rubber lid of the cloudy insulin bottle. Push the plunger of the syringe to force the air into the bottle. This equalizes the pressure in the bottle when you later remove the dose of insulin. Remove the needle from the bottle, but do not draw up any insulin.
- Pull the plunger of the syringe back and draw air into the syringe equal to the number of units of clear insulin to be given.
- Push the needle of the syringe into the rubber lid of the clear insulin bottle. Push the plunger to force the air into the bottle. Leave the needle in the bottle.
- Turn the bottle and syringe upside down, and hold them in one hand. Position the tip of the needle so that it is below the surface of insulin in the bottle. Pull back the plunger to fill the syringe with slightly more than the correct number of units of clear insulin to be given.
- Tap the outside (barrel) of the syringe so that trapped air bubbles move into the needle area. Push the air bubbles back into the bottle. Make sure that you have the correct number of units of insulin in your syringe. Remove the needle from the clear insulin bottle.
- Insert the needle into the rubber lid of the cloudy insulin bottle. Do not push the plunger, because this would force clear insulin into your cloudy insulin bottle. If clear insulin is mixed in the bottle of cloudy, it will change the action of your other doses from that bottle.
- Turn the bottle and syringe upside down and hold them in one hand. Position the tip of the needle so that it is below the surface of insulin in the bottle. Slowly pull back the plunger of the syringe to fill the syringe with the correct number of units of cloudy insulin to be given. This will keep air bubbles from entering the syringe. Remove the needle from the bottle.
- You should now have the total number of units for the clear and cloudy insulin in your syringe. For example, if 10 units of clear and 15 units of cloudy are needed, you should have 25 units in your syringe. Now you are ready to give the shot.
Giving the shot
Before giving your shot:
- Clean the site. If you use alcohol to clean the skin, let it dry.
- Slightly pinch a fold of skin between your fingers and thumb of one hand.
- Hold the syringe like a pencil close to the site, keeping your fingers off the plunger. It is usually recommended to place the syringe at a 90-degree angle to the shot site, standing straight up from the skin.
- Bend your wrist, and quickly push the needle all the way into the pinched-up area.
- Push the plunger of the syringe all the way in so the insulin goes into the fatty tissue.
- Take the needle out at the same angle that you inserted it. If you bleed a little, apply pressure over the shot area with your finger, a cotton ball, or a piece of gauze. Do not rub the area. Check your blood sugar more often on the days when bleeding occurs.
- Replace the cover over the needle and dispose of the needle safely. Do not use the same needle more than one time.
Where to give the shot
You can inject insulin into:
- The belly, but at least 5 centimetres (2 inches) from the belly button. This is the best place to inject insulin because it quickly absorbs insulin.
- The top outer part of the thighs. Insulin usually is absorbed more slowly from this site, unless you exercise soon after giving the shot.
- The outside of the upper arms or the buttocks. You may need help giving shots in these areas.
Your doctor may advise you to give your shots in different places on your body each day. This is called site rotation. Make sure you talk to your doctor about how to do this safely. If you rotate sites, use the same site at the same time of each day. For example, each day:
- At breakfast, give the shot in one of your arms.
- At lunch, give the shot in one of your legs.
- At dinner, give the shot in your belly.
Slightly change the spot where you give an insulin shot each time you do it. For example, use five different places on the right upper arm, then use five places on the left upper arm. Using the same spot every time can cause bumps or pits in the skin and make the shots hurt more. It may also slow down how the insulin is absorbed into your body.
Where can you learn more?
Go to https://www.healthwise.net/patientEd
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Current as of: April 13, 2022
Author: Healthwise Staff
Medical Review:Adam Husney MD - Family Medicine & Kathleen Romito MD - Family Medicine & Rhonda O'Brien MS, RD, CDE - Certified Diabetes Educator & David C.W. Lau MD, PhD, FRCPC - Endocrinology