How To Inject Insulin Insulin injections with an insulin pen follow a set procedure When you are injecting

insulin, you should aim to inject into the fatty tissue just underneath the skin. If you think you are injecting into the muscle, you may want to change your technique or ask your GP to prescribe shorter needles. The steps below are a broad guide to injecting insulin. If you plan to change your technique, check with your healthcare team, diabetic nurse or consultant for their advice. How to perform an insulin injection Firstly, prepare your kit. You will need: An insulin pen Enough insulin inside to give the required dose A new pen needle Cotton wool or a tissue Make sure you have your kit available at all times and if possible, inform your family as to its location. If you suffer from a hypo, this will allow your family to act quickly. Injecting your insulin shot To perform your insulin injection: Wherever possible, wash your hands with soap and water before injecting Put a new needle onto your pen Perform an air shot of at least 2 units to clear any bubbles out of the needle if you do not get a steady stream, repeat the air shot until you do get a steady stream Dial up your dose how you do this exactly may depend on which pen you have Pick a soft fatty area to inject tops of thighs, belly, bum and triceps (not always recommended for children or thinner people) Raise a fold of fatty flesh slightly between your thumb and fingers - leaving plenty of space between to put the needle in Put the needle in if you are particularly slim, you may need to put the needle in at a 45 degree angle to avoid injecting into the muscle Push the plunger, to inject the dose, relatively slowly After the dose has been injected, hold the needle in for a good 10 seconds to prevent too much insulin from escaping out If any blood or insulin escapes, wipe this with cotton wool or a tissue Ensure that the used needle into a sharps bin is deposited into a sharps bin How to avoid pain when injecting insulin Many diabetic patients are worried about the pain of injecting insulin. There are several methods that can help avoid or minimise pain when injecting. Making sure the muscles above which youre injecting are relaxed, this will allow for a better coverage o f fat where youre injecting. Use insulin and a needle which is at room temperature Push the needle in quickly Try not to wiggle the needle as youre injecting or withdrawing the needle Always use a brand new needle Injections and bruising You may notice a little blood leaks out after injecting. This is not to worry about, it just means the needle has gone through a small blood vessel. If this happens, you may notice a raised area of your skin from the blood underneath but this should ease down over the next few hours and youll be left with a bit of a bruise for a few days. Rotate your injection sites to avoid lumpy skin If you tend to inject in the same places you may find that your flesh becomes less flexible than usual. This is called lumpy skin and means the insulin wont be absorbed as well. est your skin, where you inject, to see if you have lumpy skin - your flesh should feel as supple as it is on the rest of your body.

If it is not, you may need to rotate your injection spots better. Lumpy skin can also lead to the area of flesh sticking out more than usual, this is easier to notice on the arms and tummy. This is known as insulin injection site rotation. Each of the main four areas (abdomen, buttocks, outer thighs and upper arms) should give a give a good area of flesh to inject into. However, you may find you have a favourite part of that area to in ject into. If this is the case, try injecting into surrounding areas, picking a new spot each time. One way to pick a non-lumpy area is to feel or squeeze the skin before injecting insulin. If it doesnt feel as supple as it could be, pick a different spot to inject into. Injecting Insulin Injecting insulin is a regular activity for many people with diabetes Injecting insulin is an essential part of the daily regime for many diabetics. Although insulin that can be inhaled is now available and approved, the reality is that most type 1 diabetics (and type 2 diabetics who require insulin) will have to continue injecting insulin until it is more common. Does injecting insulin hurt? Needle technology for insulin injection has become much better in recent years, meaning that the injection process, although not pain-free, does not hurt as much as it used to. Many patients still find injecting insulin to manage their diabetes an unpleasant process, however. Is injecting insulin and having diabetes going to change my life? Unfortunately, having diabetes does lead to lifestyle complications. For insulin therapy to be effective, it is necessary to make certain lifestyle changes. These should include: eating healthily exercising regularly testing blood glucose regularly and following a strict insulin regimen Although adhering to all these changes does influence your daily routine, the benefits for diabetics are enormous. Into what part of my body should I inject insulin to best help my diabetes? The abdomen is the most common site for injecting insulin. For some people, this site is not suitable, and other sites must be used. These include the upper arms, the upper buttocks and the outside of the thigh. All of these sites are most effective because they have a layer of fat to absorb the insulin better. This process directly injects insulin into the subcutaneous tissue. These areas also have fewer nerve endings, meaning that they are the least Should I switch the site where I inject insulin? Your healthcare team should be able to help you to decided the best places to inject insulin, when you should rotate them, and where to. Some diabetics use different sites for different types of insulin injection. Insulin is absorbed differently through the various injection sites. Some sites are better for rapid absorption (abdomen), whereas others are better for slow absorption (thighs, hips.) Injections should be moved around in one area, changing sites completely once every week or two. Make sure that each injection is an inch and a half away from the last one. Use the same area for at least a week, and be aware that the injection site will affect blood sugar levels. Is it possible to inject insulin through clothing? There are several reasons why injecting insulin through clothing is a bad idea, however convenient it may seem. Both syringes and pens are lubricated in order to make them as painless as possible. Clothing can remove this lubrication, meaning injections can be more painful. Clothing is not sterile, and substances on the clothing may contaminate the needle and at its worst this can lead to infection. Furthermore, clothing can damage the effectiveness of the needle by dulling the tip. Possibly most seriously, clothing restricts your view of the injection site, leaving the patient unaware of the effectiveness of their injection. A member of my family is diabetic and wants me to help them inject insulin, how should I do this? Knowing the proper techniques, having formal training from a nurse, understanding their requirements and making sure that you keep hygiene at the forefront of your mind are all important factors when injecting another person. Insulin Site Rotation Many people with diabetes keep a food diary If you have to start injecting, you are told to rotate your sites. A site is the place you put your injection in. The idea is not to use the same site too often. Rotating where you test from

Therefore, you should consider using a system whereby you maybe either rotate clockwise around your stomach so that each injection is at least an inch away from the last one - hey, go anti-clockwise sometimes, what the heck! Or rotate around your legs, arms, stomach and (for some of us old-timers, we were told to use our upper, outer buttock region as well, if you can still reach them - this area tends not to get include much these days, but still a viable option). Does injecting insulin hurt? It sounds easy enough, but there are issues with site rotation when you have a long-term medical condition such as diabetes. For example, with modern needles being as tiny as they are, and oft en entirely painless, its possible to completely forget where you injected. We all do it once in a while - non diabetics never understand it, but once youve clocked up a few hundred injections. 5 a day for just 40 days - each individual one is less likely to stick in your memory. In the old days, with bigger needles, an injection would leave a mark and you could see where you had your last injection. Not these days - thankfully. Top tips & Things to watch out for with Insulin Site Rotation On two insulins? Keep the sites separate. You might want to do short-acting insulins in your tummy (easier to access at meal times) and your long-acting insulins in your legs or arms. That way the long-acting cant induce a longer action on your short-acting. Lumps? These form when you use the same site over and over again. Lumps is not a very technical term, your diabetes team will call them lipos, short for lipoatrophy the localized loss of fat tissue due to injecting insulin into the same place often. They can look both like lumps or hollows. Loss of feeling? Just try to notice if thats happening, because if it is, you may well be tempted to keep injecting into that site as you cant feel it, but you wont be doing you or your skin any favours and your insulin absorption rates are likely to be affected and that will adversely affect your diabetes control. Injection Sites Injection sites should have a layer of fat If you inject insulin regularly, you will need to vary the areas of skin you inject your insulin into to ensure your insulin gets absorbed consistently. Also, by rotating your injection sites, you can avoid developing stiffer, lumpy skin helping you to feel happier. Which areas can be injected into? Ideal areas to inject into are parts of the body with a decent layer of fat. The belly, upper arms, thighs and buttocks are commonly used. Note that some parts of the body absorb insulin quicker than other parts. The quickest area to be absorbed from is the belly, followed by the upper arm, then the thighs and lastly the buttocks. [24] Charity Diabetes UK warn that the arm may not always be a suitable injection for people with less body fat [25] as there is a greater chance of injecting into a muscle which could lead tohypoglycemia. Injecting in the same general area for the same type of meal To have consistent absorption of insulin, its recommended to inject in the same general area of the body for the same type of meal. For example, for breakfast it may be a good idea to inject short term or bolus insulin into the belly. For long acting or basal insulin, it might be beneficial to inject into the legs or buttocks. You can discuss which injection site is best for each meal with your health team. Rotating your injection sites If you inject regularly, its recommended to rotate your injection sites. Rotating your injection site means using a different spot to inject into to prevent injecting into the same place each time. For example, if you injected into the left side of your belly yesterday at breakfast, you could inject into the right side of your belly for the next days breakfast. Youll soon need to inject into the left side of your belly again, but when you do, pick a different part o f that side of the belly to inject into. It can help to imagine a grid drawn onto your body and youd aim to pick a different square to inject into with each new injection. After some time, youd need to inject into the first square you chose but that should usually have fully healed by that time.[25] Why do I need to rotate my injection sites? If you inject in the same place too often, your skin may start to become stiffer, often describ ed as being lumpy. The official term for this is lipohypertrophy and is the result of extra fat being produced at that part of the body.

This poses two potential problems. The first is that injecting into lumpy skin can mean that insulin doesnt get absorbed as consistently as normal. The second problem being that lumpy skin can look less attractive. At clinic visits, your health team will usually check the skin at your injections sites to ensure youre not getting lumpy skin. If you are, they can help to advise you how to prevent it. What does aspiration mean? Aspiration involves pulling the plunger of the syringe back once it is injected to see if blood enters the barrel of the syringe. Blood means a need to shift to another site. However, aspiration is no longer needed when injecting insulin, according to medical experts. Should I pinch the skin at the injection site in order to reduce leakage when injecting insulin? When a needle penetrates the skin, tiny holes in the skin and fat beneath are created. There is a possibility that insulin can leak from these holes when the needle is removed. If you pinch the skin before injecting, the lined-up nature of the holes is disrupted, meaning improved effectiveness. History of Insulin Insulin's timeline starts back in 1869 The discovery and development of insulin as a medical treatment can be traced back to the 19th century. Research into the development of insulin has driven scientists to take significant steps towards understanding human biology and a number of Nobel Prizes have been awarded for research into the hormone. Discovery of endocrine role of the pancreas 1869: Paul Langerhans, a medical student in Berlin discovers a distinct collection of cells within the pancreas. These cells would later be called the Islets of Langerhans. 1889: Oscar Minkowski and Joseph von Mering remove the pancreas from a dog to study the effects on digestion. Sugar is found in the dogs urine after flies were noticed to be feeding off the urine. 1901: Eugene Opie discovers that the Islets of Langerhans produce insulin and that the destruction of these cells resulted in diabetes Experimental usage of insulin 1916: Romanian Professor, Nicolae Paulescu, develops an extract of the pancreas and shows that it lowers blood sugar in diabetic dogs. World War I prevents the experiments from continuing and it is not until 1921 that Paulescu publishes evidence of the experiments. [81] 1921: In Toronto, Canada, Dr Frederick Banting and medical student Charles Best perform experiments on the pancreases of dogs. Professor John Maceod provided Banting and Best with a laboratory and dogs to carry out the experiments. The pancreas of a dog was removed, resulting in the dog displaying the signs of diabetes. The pancreas was sliced and ground up into an injectable extract and injected a few times a day into the dog which helped the dog to regain health. Given the early success, Macleod wanted to see more evidence that the procedure worked and provided pancreases from cows to make the extract which was named insulin. Bertram Collip, a biochemist, joined the research team to provide help with purifying the insulin to be used for testing on humans. Banting and Best clearly had confidence in the insulin as they were the first humans to test the insulin by injecting themselves with it which caused them to experience weakness and dizziness, signs of hypoglycemia. After the group had experimented enough to gain an understanding of the required doses and how best to treat hypoglycemia, their insulin was deemed ready to tried on patients. First usage of insulin as a medical treatment 1922: The first patient, Leonard Thompson a 14 year old boy with type 1 diabetes is given the first medical administration of insulin. Previously patients with type 1 diabetes would be put onto starvation diets and would have only months to live. Leonard lived another 13 years before succumbing to pneumonia. Insulin manufactured 1922: As news of insulins success spread, Banting and Best begin receiving letters asking for help for others with type 1 diabetes. Banting and Best improve their techniques for the production of insulin and Eli Lilly becomes the first insulin manufacturer. 1923: Banting and Macleod are awarded the Nobel Prize in Physiology or Medicine. Banting and Macleod, however, felt Best and Collip were equally eligible and shared their prize money with the two colleagues. [82] 1936: Hans Christian Hagedorn discovers the action of insulin can be prolonged with the addition of protamine. 1950: NPH, an intermediate acting insulin, is marketed by Danish company Novo Nordisk. Sequencing and synthesis of insulin 1955: Insulin is sequenced by Frederick Sanger, and is the first protein to be fully sequenced. In1958 Sanger receives the Nobel Prize in Chemistry for his research in this area.

1963: Insulin becomes the first human protein to be chemically synthesised. 1978: Insulin is then the first human protein to be manufactured through biotechnology, using bacteria to grow the insulin protein by a company called Genentech. 1982: Synthetic insulin is named human insulin marking it as distinct from insulin derived from animals. Human insulin has the advantage of being less likely to allergic reactions than animal insulin. Humilin, manufactured by Eli Lilly, becomes widely available through the 1980s. Analogue insulin 1996: Eli Lilly markets the analogue insulin lispro under the trade name Humalog. Analogue insulin is a genetically modified form of insulin whereby the amino acid sequence is altered to change how the insulin is absorbed, distributed, metabolised and excreted. [83] Multiple Daily Injections vs Insulin Pumps Some type 1 diabetics may be offered the choice of MDI or insulin pump Some people with type 1 diabetes will be offered the choice of staying on multiple daily injections or starting on an insulin pump. We look at some benefits and disadvantages of insulin pumps and multiple injections. Benefits of insulin pumps Insulin pumps: Cannulas are put into the skin every few days Injections: Injections are needed several times a day. Insulin pumps: Press buttons to deliver a dose at each meal or snack. Injections: Need to inject for each meal and some snacks. Insulin pumps: Basal insulin can be turned off or reduced during and after sports Injections: Any changes to basal insulin needs to be done up to several hours in advance Insulin pumps: Basal insulin is constantly delivered. Injections: Need to remember to inject background insulin at specific times of the day. Insulin pumps: Pumps can be programmed to deliver more insulin at certain times of the day, even when asleep if required. Injections: Any increase in insulin must be injected manually. Benefits of injections Insulin pumps: Can only be disconnected for short periods of time. Injections: Need only appear when an injection is needed. Insulin pumps: Can occasionally have issues, such as air bubbles, which can adversely affect blood glucose levels. Injections: Can also suffer from air bubbles is generally less of a problem. Insulin pumps: Tubing can sometimes get caught on objects such as door handles, if tubing is not kept covered. Injections: No tubing. Insulin pumps: Have a steeper initial learning curve to adjust to using and caring for a pump. Injections: Less complicated to learn to use and maintain insulin pens. Diabetes and Sharps - Storage and Disposal

Disposing of sharps correctly is important to avoid contamination. Disposal of sharps such as needles and lancets affects most people with diabetes. Used needles can cause hygiene issues and injuries, and include serious risks such as HIV contamination. The psychological damage of an injury related to sharps is also significant, and therefore every individual has the responsibility to dispose of sharps safely. There are a number of simple sharps disposal tips that people with diabetes can take on board to minimise the likelihood of injuries or contamination: Never share a syringe or finger pricker/lancet Keep all needles and glucose monitoring equipment clean and free of blood

Keep all sharps out of reach of children at all times Once sharps are in a disposal box, never try to get them out Storing and disposing sharps Sharps such as those used by many people with diabetes are clinical waste. This means that, unless they are certified safe as domestic waste (such as some of the most recent finger-prickers) there should be a specific means of disposal. Needles, syringes and lancets should be disposed of in a specially designated sharps disposal box, not in a fizzy drink can, plastic bottle or similar container. Sharps should be disposed of in a sharps disposal box or some people prefer to use a clipper, which then itself needs to be disposed of in a sharps disposal box. Both clippers and sharps disposal boxes are available in the UK on prescription. However, clippers cannot be used to dispose of lancets. Sharps disposal boxes come in a variety of sizes, some of which are suitable for travel. If you do not know which one you need, consult your healthcare professional. What to do when the sharps disposal box is full A number of schemes are in place in the UK, and your HCP should be able to tell you how to dispose of your box. This could involve taking it to a GP surgery or pharmacy, or even having it collected by the local council. Your local council has a duty to collect your sharps bin, but you may have to request this and they may charge you. Travelling with sharps When travelling with sharps, it is essential to check with your GP to make sure all disposal equipment is included in an accompanying letter. The guidelines about sharps disposal in foreign countries should be available from the national diabetes body wherever you are visiting. What the community are saying about Sharps Disposal Synonym: I think that there should be some provision made for disposing of what is clearly hazardous waste. I got my sharps box from the hospital clinic and anticipate/hope that they will exchange it when necessary. China: At both my GP's surgery and local dispensary there are notices asking people to contact the local council for a free sharps box - and the relevant contact details given. The Council's environmental/recycling department have responsibility for disposing of sharps equipment in the appropriate manner. I phoned up and received my box 2 days later. What a brilliant service! Serena51: My sharps box was written up on the prescription when I got my test strips and lancets for the first time. Only problem is how to dispose of once full as both the chemist and the DN had told me that each other would take it. christineb: I am having problems getting somebody to take my sharps bin. Pharmacy wouldn't take it, GP surgery wouldn't take it and Diabetic Clinic wouldn't take it. I was told by one place to wrap it up in bubble wrap and put it in the Bin! Roo.be: I would advise against putting any medical surplus in the household waste as the bin men can refuse to empty your rubbish if they any suspicion of dangerous items being put in them, especially sharps. Insulin Pens Insulin pens are easy to use and often have replaceable pen needles Insulin pens are common in the United Kingdom, and are generally characterised by a different shape and the fact that they use an insulin cartridge as opposed to a vial. Some insulin pens use replaceable cartridges, and others use non-replaceable cartridges and must be disposed of after being used. Most insulin pens use replaceable insulin pen needles, which have become extremely short and thin. The replaceable cartridges for insulin pens come in 3 and 1 ml sizes, although 3 is more common and has become dominant. Prefilled insulin pens are disposed of when the insulin within the cartridge is used up. Prefilled pens are often marketed for type 2 diabetics who need to use insulin. Insulin Pens Browse through our list of insulin pen reviews. You can also buy the insulin pens from the Diabetes Shop. Simply click on an insulin pen name to read the guide. How do I use an insulin pen to treat my diabetes? Using a pen is a relatively easy process. Some pens require gentle shaking before use. Once the cartridge is loaded, screw on a needle and prime the pen to clear air. Then dial in the exact dose that you require to deliver the insulin to the body. What is good about insulin pens as opposed to syringes? Insulin pens are very easy to use. They are great for young diabetics who need to deliver insulin at school. Furthermore, many diabetics find insulin pens almost painless. They are also portable and discreet, as well as not

being as time-consuming as syringes. An accurate dose can be pre-set on the dosage dial, which can be useful for diabetes sufferers who also have impaired vision. Why might I not like insulin pens? Insulin pens are not right for 100% of diabetes patients. Insulin in pens and cartridges is generally more expensive than bottled insulin and syringes. When pens are used a small quantity of insulin is wasted, making the process less economical. Not all types of insulin are available to be used in insulin pen cartridges at this stage. Furthermore, insulin pens do not let you mix two different types of insulin, meaning in some cases two separate injections will need to be administered. Can I leave the needle on and take my insulin pen around with it ready to use? Absolutely not. This could influence the sterility of the needle, and alter the dose of insulin administered when you come to use the pen. Keep pens and needles separate until you are ready to inject, and remove the needle immediately after use. How do I choose the right insulin pen for my diabetes? There are numerous different brands and models of insulin pens available in the UK market. As a diabetic working with your healthcare team to establish what insulin pen to choose, the following factors are worth considering. What types of insulin are available for the pen (may be limited.) How many units the pen can hold when full, and how large a dose can be injected. The adjustment method of the pen, and how finely this can be tuned This size of the numbers on the pen, and in cases with impaired vision whether they are magnified. How hard it is to operate the pen. How the pen indicates how much insulin is left within the barrel. Insulin Pen Needles Insulin needles come in a range of sizes Insulin pen needles and disposable syringes come in a variety of lengths and widths to suit all body types. From 12mm to 8mm and now down even to 4mm, the needle length you choose is likely to be dictated by your size, children being likely to benefit from the shorter 6mm size. Your healthcare team should be able to advise you as to the best needle for your body shape. When it comes to injecting, to reduce any likely pain it is essential to get the right kit and use the right technique. Hence, be careful not to fall into sloppy habits as they might lead to irritation at the site of injection, and result in your overall irritation at sore injections. You should also rotate your insulin injection sites. Insulin needle guides Read product guides from Sue Marshall with user reviews for insulin needles and accessories. You can buy pens, needles and accessories from the Diabetes Shop. Reusing Insulin Pen Needles Re-use of needles is associated with greater pain Insulin pen needles are intended for single use only but it is known that a significant proportion of people with diabetes do re-use needles. People with diabetes ultimately have the choice of whether they wish to re-use needles for injections. This article reviews evidence from research studies to help you make an informed decision about re-use ofpen needles. Whilst this guide refers to insulin pen needles, the same principles will also apply to pen needles for injections of incretin mimetics such as Byetta and Victoza. What are the risks involved in reusing needles? Reusing insulin pen needles could increase the following: Bacterial growth on the needle Likelihood of experiencing pain when injecting Risk of lipohypertrophy (lumpy skin) occurring Risk of the very fine tip of the needle breaking off The risks of the above will grow with each re-use. Re-use of needles and bacterial growth A study carried out at the Moscow Regional Research Clinical Institute found that bacteria were present after injections had been completed and that bacterial growth on needles increased with further re-use. Bacteria found on the needles was mainly bacteria found naturally on skin (staphylococcus epidermidis). Whilst this form of bacteria is usually harmless, re-use of needles could increase the risk of contamination of more harmful bacteria. Re-using insulin needles and pain

The fine tip of needles can become slightly distorted with re-use and this can increase the chance of experience pain whilst putting the needle in or taking the needle out. If you are experiencing pain when withdrawing the needle, this could well be caused by distortion to the tip of the needle. The Moscow study referenced above showed that re-use of needles is associated with more pain. The study divided patients into groups that re-used needles and those that didnt. Those that re-used needles in the study communicated higher levels of pain with their last injection. Insulin Jet Injectors Insulin jet injectors are a complex and relatively recent development in diabetes management. This type of device sends a fine spray of insulin through the skin using a high-pressure air current as opposed to a needle. Insulin jet injectors are an amazing alternative for those people with diabetes who have needle phobia. However, this type of device is expensive and requires frequent sterilisation. Insulin Inhalers Similarly under development and refinement, insulin inhalers could have a big role to play in the future of diabetes management. Some insulin inhalers have already been brought to market, with others still works in progress. Insulin inhalers may use compressed air to deliver a dose of dry insulin or dissolved rapid-acting insulin that can then be inhaled. The dose is inhaled through the mouth and goes directly into the lungs, where in theory it is absorbed and passes into the bloodstream. Most insulin inhalers use rapid-acting insulin, and for this reason they do not totally replace insulin injections. However, inhaling fast and slow acting insulin is under development and research teams indicate strong performance. Concerns have existed over long-term insulin inhaler use and how this will affect the lungs. Similarly if a person with diabetes gets a cold would they still be effective. Furthermore, the consistency and adjustment of dose is also being considered. Multiple Daily Injections vs Insulin Pumps Some type 1 diabetics may be offered the choice of MDI or insulin pump Some people with type 1 diabetes will be offered the choice of staying on multiple daily injections or starting on an insulin pump. We look at some benefits and disadvantages of insulin pumps and multiple injections. Benefits of insulin pumps Insulin pumps: Cannulas are put into the skin every few days Injections: Injections are needed several times a day. Insulin pumps: Press buttons to deliver a dose at each meal or snack. Injections: Need to inject for each meal and some snacks. Insulin pumps: Basal insulin can be turned off or reduced during and after sports Injections: Any changes to basal insulin needs to be done up to several hours in advance Insulin pumps: Basal insulin is constantly delivered. Injections: Need to remember to inject background insulin at specific times of the day. Insulin pumps: Pumps can be programmed to deliver more insulin at certain times of the day, even when asleep if required. Injections: Any increase in insulin must be injected manually. Benefits of injections Insulin pumps: Can only be disconnected for short periods of time. Injections: Need only appear when an injection is needed. Insulin pumps: Can occasionally have issues, such as air bubbles, which can adversely affect blood glucose levels. Injections: Can also suffer from air bubbles is generally less of a problem. Insulin pumps: Tubing can sometimes get caught on objects such as door handles, if tubing is not kept covered. Injections: No tubing. Insulin pumps: Have a steeper initial learning curve to adjust to using and caring for a pump. Injections: Less complicated to learn to use and maintain insulin pens. Why has the development of non-invasive insulin delivery devices taken so long? The reason why non-invasive insulin delivery has taken so long to get right is the fact that insulin gets destroyed if its ingested. If you eat or drink insulin, the stomachs digestive juices simply destroy it. However, there are other ways being investigated as alternatives to injections or insulin pump infusion sets. Nasal insulin

For a brief while there was a nasal insulin available called Exubera. However, it just didnt catch on. The delivery equipment was something that looked very much like a bicycle pump that you used to stick up your nose and deliver a dose of air-borne insulin. It was big to carry around and frankly must have felt odd to use and looked even worse. Fundamentally, only the extremely needle-phobic preferred to use it. The approval of the world's first inhaled insulin marked an important advance in the treatment of diabetes that began with the discovery of insulin in the 1920s. However, the success of this innovative diabetes treatment has proved relatively short lived, as the company decided in October 2007 to withdraw the product from the market as sales of Exubera had proved disappointing. Exubera was described as a patient-friendly agent that was thought to be especially welcome to type 2 diabetic patients who are new to insulin therapy and reluctant to use injectable insulin. Among type 1 patients with diabetes, Exubera was seen as providing welcome relief from the need to give daily, meal-time insulin injections. However, these patients still needed injectable long -acting insulin therapy. Inhaled insulin research Research is presently continuing with inhaled insulin (Technosphere) for type 2 diabetes whereby it is used only with meals whilst there is also an injected basal dose of insulin glargine. Fundamentally, only the extremely needle-phobic preferred to use it. The approval of the world's first inhaled insulin marked an important advance in the treatment of diabetes that began with the discovery of insulin in the 1920s. However, the success of this innovative diabetes treatment has proved relatively short lived, as the company decided in October 2007 to withdraw the product from the market as sales of Exubera had proved disappointing. Exubera was described as a patient-friendly agent that was thought to be especially welcome to type 2 diabetic patients who are new to insulin therapy and reluctant to use injectable insulin. Among type 1 patients with diabetes, Exubera was seen as providing welcome relief from the need to give daily, meal -time insulin injections. However, these patients still needed injectable long -acting insulin therapy. Inhaled insulin research Research is presently continuing with inhaled insulin (Technosphere) for type 2 diabetes whereby it is used only with meals whilst there is also an injected basal dose of insulin glargine. This is being compared to a twice-daily injectable insulin for type 2 diabetes. The use of insulin therapy is often put off when treating patients with type 2 diabetes because it is associated with weight gain, hypoglycemia, and the need for subcutaneous injections. Solid Dose Injector The Glide SDI (Solid Dose Injector) is a new form of technology developed by Glide Pharma, a specialty pharmaceutical company. The Glide is less invasive than traditional injection methods and should make the injecting experience less painful and less upsetting by allowing the injection of solid formulations. The Glide opens up a wide range of therapeutic options for new and existing treatments. Lipoxen Plc. has entered into an agreement with developing a diabetes treatment product for use with Glides needle -free drug delivery technology to deliver Lipoxens long-acting insulin, SuliXen. Also in the pipeline, an Australian company is developing an insulin gel patch in collaboration with the Joslin Diabetes Center at Harvard Medical School. Meanwhile, a Japanese company is developing an insulin nasal spray with Hoshi University in Tokyo. Alternative to needles So, there is some hope that a realistic alternative to needles is on its way. Should they be forthcoming, it may also undermine the need for insulin pumps too. Youd think that there would be a lot of interest in developing this solution for what is a huge (and growing) market. With contributions from Diabetes Expert: Sue Marshall. Multiple Dose Insulin Therapy - Multiple Daily Injections Multiple daily injections involves four or more daily insulin injections Multiple dose injection (MDI) therapy, also known as multiple daily injections, is an alternative term for the basal/bolus regime of injecting insulin. The therapy involves injecting a long acting insulinonce or twice daily as a background (basal) dose and having further injections of rapid acting insulin at each meal time. Multiple daily injection therapy will usually involve at least four injections a day. What is a non-MDI regime? Before analogue insulins, insulin injections would commonly be given twice daily.

The injections would often include a mixture of short acting and intermediate acting insulins. Injections would usually be administered once in the morning, before breakfast, and once before the evening meal; therefore dividing the day into two periods of roughly 12 hours. This meant that once youd injected a dose, the balance of c arbohydrates and activity you take over the next 12 hours would need to correspond to the last dose you injected. What are the benefits of multiple dose insulin therapy? On multiple daily injections, there is more freedom as you dont need to plan so far i n advance or be so restricted byinjections delivered a number of hours ago. Because MDI involves rapid acting insulin, it has allowed people to wait less time before eating after injecting. Depending on the overall GI content of a meal, some people may be able to inject during or after a meal, without their blood sugar spiking too much. Generally speaking, rapid acting insulin helps to reduce the effect of high blood sugar levels 1-2 hours after eating. Furthermore a multiple dose regime allows more flexibility as to when meals can be taken. Speed of action and correction doses The speed of action of rapid acting insulin also allows people to make correction doses, should they need to. A correction dose is a dose that is given between meals if ones blood sugar has risen too high. Correction doses are best left to those who are confident with adjusting their insulin as correction dose errors can lead tohypoglycemia. What are the disadvantages of multiple daily injections? Multiple daily injections should be accompanied by a strong understanding of how the regime works particularly as rapid acting insulin can lead to faster onset of hypos if dosing errors are made. A potential disadvantage of the extra freedom allowed by multiple daily injections can lead to more chances being taken, such as eating types or quantities of foods that one wouldnt eat on a twice daily regime. Who can benefit from a multiple daily injections regime? The multiple daily injections regime is well suited to adults, as the regime offers the flexibility which is sometimes needed. Teenagers who are confidence with the idea of adjusting their own insulin may also find benefits. Pre-teenage children may benefit if parents are confident with insulin dose adjustment and can make time to administer doses before each meal or ensure that their childs school can. Multiple daily injections may not be advisable for those who are not confident in adjusting insulin, such as with children, older people or those who may find the regularity of decisions about dosing difficult to manage on a daily basis. For some people, such as children and older people, the reduced flexibility of a twice daily regime may actually confer some advantages. For instance, the lack of flexibility may help to reinforce eating the right quantities of the right food and at regular times. What factors affect insulin dosage? Carbohydrate intake Physical activity Illness Body mass Insulin resistance Carbohydrate intake The more carbohydrate you eat, the more insulin you will need to take. Physical activity When we are active, the body requires glucose to fuel our muscles and this can cause blood glucose levels to drop either during or after exercise. Exercise increases sensitivity to insulin for up to 48 hours and may require a reduction to insulin doses. Illness When we are ill, our body will typically raise our blood glucose levels. During periods of illness, we will likely need to take more insulin than usual. Body mass Typically, the bigger you are, the more insulin you will require. Children with type 2 diabetes, for instance, will likely find that their insulin requirements steadily increase as they get older.

Insulin resistance This is a characteristic of type 2 diabetes. A larger resistance to insulin will mean that more insulin will need to be injected to achieve a reduction in blood glucose levels. llergic reactions to insulin or side effects Whilst relatively rare, people may experience signs of allergic reactions or side effects on different types of insulin. This is slightly more likely if switching from an animal insulin to a synthetic insulin, or vice versa. However, a switch between different types of brands of insulin can also have this effect. Allergic reactions or side effects may include redness, swelling or itching at the site of the injection. If the effect happens regularly or for a significant period of time, it is important to mention to your doctor or health team. More advanced allergies, which are more rare, include nausea and vomiting. Speak to your health team if these symptoms occur. Read more on side effects of insulin Speed of the insulin Different insulins tend to have different speeds of action. Sometimes the speeds of action will be similar, Read our reference table on quickly different types of insulin tend to start, have there peak action and their duration. Insulin actions and durations How quickly does the insulin begin to act? How quickly the insulin starts to act is a consideration that usually applies to short and rapid acting insulin and may dictate when you take your insulin in relation to a meal. Some insulin, such as short acting insulin may be taken a period of time in advance of a meal, whereas some rapid acting insulins may need to be injecting immediately before a meal. Your health team should advise you of when, in a relation to a meal, your particular insulin should be taken. When is the peak action of the insulin? This is useful to be aware of for any insulin, whether it is rapid, short, intermediate or long acting. Knowing when the insulin is at its peak can be a useful in avoiding hypoglycemia. How long does the insulin last? This question is often of importance for intermediate and long acting insulin, but can apply to any duration. Long acting insulin can last for as long as a day and some animal insulins can last longer. Why does it matter how long the insulin lasts? Knowing how long the insulin lasts can play a part in knowing when to inject or whether you may need to inject the insulin twice a day. People who switch from Lantus to Levemir will often go from injecting once a day to twice a day for example. Ask your health if you have any questions about how the speed or duration of your insulin may affect you.