How to administer insulin

Mechanism of insulin action

  • Insulin is a hormone naturally produced by the pancreas in your body. Insulin helps with shifting the glucose from the blood into the cells of body tissues. This helps with regulating the blood sugar levels. Also, glucose transported into the cells provides nutrition to the cells and thus is utilized for the metabolism and normal function of body cells.
  • Type-1 diabetes is a condition in which your immune system destroys the insulin producing cells in pancreas. This results in reduced or no insulin production by the body. Reduced or lack of insulin hormone leads to poor shifting of glucose from the blood into the cells of body tissues.
  • Type-2 diabetes is a condition in which your body becomes resistant to the action insulin. Resistance to action of insulin hormone leads to poor shifting of glucose from the blood into the cells of body tissues.
  • Either Type-1 or Type-2 diabetes, poor shifting of glucose from the blood into the cells of body tissues from compromised insulin action results in poor control and regulation blood sugars. This leads to increased sugar levels in the blood and reduced availability of sugar for the cells and tissues.
  • Sugar (glucose) is the primary source of nutrition and energy for all the vital organs and tissues like kidneys, heart, and skeletal muscle in the body. As glucose is poorly available for nutrition of these cells in diabetic individuals, function of vital organs and tissues can suffer. This leads to diabetes symptoms, such as, feeling very tired, confusion, fatigue, and feeling increasingly hungry.
  • Glucose is initially easily filtered into the urine by kidneys and later is almost completely reabsorbed back into the body from the renal tubules. High glucose in the blood in poorly managed diabetics, initially leads to more glucose filtered into the urine by kidneys. Despite some glucose being reabsorbed into the body later from the renal tubules, still significant amounts of glucose is eliminated in the urine. Glucose, while getting eliminated, carries water along with it. Increased amounts of glucose eliminated in the urine of poorly controlled diabetics carry high volumes of water along. This results in poorly controlled diabetics urinating frequently contributing to increased fluid loss from the body. As more fluid is lost from the body, unless timely replenished, these individuals lose weight quickly, become increasingly thirsty, hypotensive, confused, and develop dry skin.
  • Insulin administered in diabetic individuals helps to promote shifting of glucose from the blood into the cells of body tissues. This helps with reducing/regulating the blood sugar levels and contributes towards improved blood sugar control. Increased glucose availability within the cells help support their metabolism and nourish body tissues better. This contributes to improve/relieve symptoms of diabetes.

 

Route of insulin administration

  • Insulin is administered into the less sensitive layer of fatty tissue, just underneath the skin (subcutaneous fat). Injecting insulin into the fat layer beneath the skin can help absorption of insulin into the blood stream at a desired and consistent rate.
  • To facilitate insulin administration into the subcutaneous fat, insulin is administered via insulin syringe, insulin pen, or insulin infusion. The syringes/needles used for insulin administration are different from the syringes/needles used for intramuscular/intravenous administration of many other medications. The insulin syringes are smaller, leaner, and marked in units in comparison to the intramuscular/intravenous syringes that are marked in milliliters with longer and thicker needles.
  • Do not use the intramuscular/intravenous syringe for insulin administration. This can result in administration of wrong dose of insulin. Also, administering insulin deep into the muscle or directly into the vein, using the intramuscular/intravenous syringe, can lead to rapid absorption and action of insulin. This can contribute to quicker and severe lowering of blood sugars leading to impaired blood sugar regulation, compromised therapeutic benefit of insulin administration, and hypoglycemic emergency.

 

Sites for insulin administration

  • Insulin is administered into the less sensitive layer of fatty tissue, just underneath the skin (subcutaneous fat). Injecting insulin into the fat layer beneath the skin can help absorption of insulin into the blood stream at a desired and consistent rate.
  • Insulin can be injected into the subcutaneous fat available at various body sites by using insulin syringe, insulin pen, or even insulin infusion.
  • Subcutaneous fat is richly available in various body sites, such as, abdomen, upper & outer arms, hips, and upper & outer thighs. This makes them preferred sites for insulin administration.
  • Insulin can be administered subcutaneously, preferably into the anterior abdominal wall, leaving a 2 inch circle around the navel. Insulin injected into this site is quickly and consistently absorbed among all the other sites for insulin administration, which makes it the most preferred site. The 2 inch circle around the navel can have tougher subcutaneous tissue, can compromise insulin absorption, and thus, is avoided.
  • Insulin can be administered subcutaneously into the upper & outer arms. Insulin injected into this site is absorbed with moderate speed and slower than the insulin injected into the subcutaneous fat on the abdomen. Avoid administering into this site, if the individual lacks fatty tissue in the upper & outer arm.
  • Insulin can also be administered subcutaneously into the hips and upper & outer thighs. Insulin injected into these sites is slowly absorbed in comparison to all the other preferred sites for insulin administration. While administering insulin into this site, make sure you are not administering the medication too close to any bony area in the lower extremity, which can reduce the absorption of insulin and compromise the therapeutic benefit of insulin administration.
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