Managing your diabetes with insulin
Taking insulin is an essential part of diabetes management for people with type 1 diabetes, and for some with type 2 diabetes. Insulin is taken by injection or through a pump. It helps to keep blood sugar levels under control.
Insulin and blood glucose levels
Insulin is a hormone you make in your pancreas. It helps move glucose from your blood into your muscle and fat cells for energy.
- If you have type 1 diabetes you will need to take insulin because your body does not produce enough insulin
- If you have type 2 diabetes you may need to take insulin because your body does not use the insulin it makes effectively.
Without enough insulin, glucose builds up in your blood stream.
When taking insulin the aim is to keep your blood glucose level as close to normal as possible — 4 to 8 mmol/L.
Types of insulin
Your healthcare provider will recommend the right type and dose of insulin to manage your blood sugar levels. There are 3 different types of insulin you can take.
- Short-acting insulin. This helps control blood sugar spikes after meals.
- Intermediate-acting insulin. This helps regulate blood sugar levels between meals and overnight.
- Long-acting insulin. This gives steady blood sugar control throughout the day and night.
Types of insulin — Diabetes New Zealandexternal link
There are 2 main ways you can take insulin.
- An insulin pen is a device containing a cartridge pre-filled with insulin — this is the most common way to take insulin.
- An insulin pump delivers insulin continuously through a thin tube under the skin.
Using an insulin pump
Your healthcare provider will talk to you about which is the best option for you.
Using an insulin pen
Preparing an insulin pen or syringe
- Wash your hands and prepare a clean hard work surface.
- Check the expiry date on your vial or pen.
- Check that the pen cartridge or vial is not cracked.
- If the insulin you use is cloudy, it may separate into 2 layers so you will need to mix it well before injecting. Gently 'rock and roll' the pen or syringe until it looks cloudy and is no longer separated.
- Prepare the pen:
- remove the cover and unscrew the top
- insert a new cartridge (threaded end first) and reattach the top
- attach a new pen needle and tighten it securely.
- Prime the pen — dial 2 units and press the plunger to ensure insulin flows. Repeat if necessary.
- Dial the correct dose as prescribed by your healthcare provider.
- Remove the lid from the insulin vial (bottle).
- Clean the rubber top of the vial with an alcohol swab.
- Remove the cap from the syringe.
- Draw back the plunger of the syringe to get air into it
- Insert the needle through the rubber cap of the vial and push the plunger all the way down to introduce air into the vial.
- Leaving the needle in the vial, turn the bottle and needle upside down.
- Pull back the plunger of the syringe to draw the insulin into the syringe.
- Stop when the fluid in the syringe is level with the marked number that is your correct dose.
- Pull the syringe and needle out of the vial.
- If you have too much insulin in the syringe, squirt the excess down the sink. Do not put it back in the vial.
How to inject insulin using a syringe — Boston Medical Centreexternal link
How to inject insulin
1. Choose an injection site:
- inject into the fatty layer of your tummy
- rotate sites between injections to prevent lumps or skin damage
- avoid injecting through clothes or into damaged skin.
2. Inject the insulin:
- pinch a small area of skin
- insert the needle at a 90-degree angle
- press the plunger fully
- count to 6 before removing the needle.
3. Store the pen properly after use.
If you forget to take your insulin
If you forget your pre-meal insulin take it directly after your meal.
If it has been longer than 30 minutes after your meal, skip that insulin dose altogether.
Handling your needles
Changing the needle
- Rapid-acting insulin — change the needle every 1 to 4 days.
- Intermediate-acting insulin — change the needle every 1 to 3 uses.
Always prime the pen (release 2 units) after replacing a needle.
What to do with used needles
Place used needles in a hard plastic container away from tamariki. Do not dispose of them in your rubbish or recycling.
Take sealed containers to a pharmacy for safe disposal.
Using an insulin pump
An insulin pump is an alternative to insulin injections. It is a small electronic device that continuously delivers small amounts of insulin through a narrow plastic tube that is inserted under your skin.
The pump is usually kept in your pocket or attached to your belt. It only delivers fast-acting insulin, so you need to wear it day and night.
Your diabetes care team will explain how to set up and use your insulin pump.
If you have a technical difficulty with your insulin pump, call the company that provided it. You may need to use injections for your insulin while the pump problem is worked out.
Wearing an insulin pump
Deciding if an insulin pump is right for you
There are advantages and disadvantages to using an insulin pump.
- Most people have fewer highs and lows. Blood sugar levels are more often in your target range.
- You do not have to inject as often.
- You can adjust your insulin more easily before, during and after exercise.
- You have more flexibility in what, when and how much you eat.
- You can be more accurate when you are bringing down high sugar levels.
- You need to have your pump attached to you all the time. You can only take it off for small breaks, like when you are swimming or showering.
- The tubing can sometimes get blocked, so you might need to change it at short notice.
- You need to take time to learn about your pump, especially when you first get it.
- There is always a small risk of infection where the sensor goes under your skin.
- You still need to inject insulin sometimes.
Storing insulin
- Unopened insulin — store in the fridge (2 to 4°C) until expiry.
- Opened insulin — keep at room temperature and throw away after 4 weeks.
Do not:
- store insulin in direct sunlight
- leave insulin a hot place or in your car
- freeze insulin.
If you are travelling:
- carry your insulin in an insulated container
- keep it in your hand luggage.
Do not use a vial, cartridge or pre-filled pen if:
- the expiry date has been reached or passed
- clear soluble insulin is cloudy (it must be clear)
- the insulin is discoloured
- the insulin has been frozen or exposed to high temperatures
- the insulin contains lumps or flakes or sticks to the glass.
Adjusting your insulin dose
Your insulin needs may change if:
- there are changes in your diet
- you are exercising more than usual
- you are ill and not eating
- regularly
- you are pregnant.
Your healthcare provider will help you adjust your insulin dose safely. Over time, you will learn to make small adjustments based on self-testing and how your body responds.
If you have low blood sugar (hypoglycemia)
Hypoglycaemia (hypo), means you have a low blood glucose (sugar) level. Any blood glucose level less than 4 is low and needs to be treated.