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Guide to Insulin Injections

This Guide is also available as a full-color, 3-page chart. Click here to download the PDF file (see below for more information on PDF files).

First things first: Are you injecting only one type of insulin, or two?  Many kids with diabetes receive both  rapid- or short-acting (clear) and intermediate- or long-acting (cloudy) in one injection. Others receive just one type in each injection.  Now, click on one of the links below for a step-by-step guide to giving injections.

Click here if you're injecting one type of insulin. 

Click here if you're injecting two types of insulin.

Rotating where your child receives shots keeps his skin healthy and aids in predicting the speed of insulin absorption. Repeated shots in the same spot can cause fat deposits—called lipohypertrophy— that make the skin look lumpy. Injecting into sites showing evidence of lipohypertrophy can delay the absorption of insulin. Lipohypertrophy can usually be prevented by regular site rotation.

In general, insulin shots can be given pretty much wherever there’s enough fat under the skin. The main areas are the abdomen, thighs, and the back of the upper arms. The abdomen is generally used the most. It’s easy to reach, and the insulin is absorbed from the abdomen at a more consistent rate from shot to shot. Site rotation is different for every person, but here are the basics.

• Each injection site should be about the size of a quarter. So you only have to move about a finger-width away from your last shot each time you rotate. You and your child should devise a way to keep track of the site rotation.

• Don’t inject too close to moles or scars.

• Some people rotate only within a certain body area, like the abdomen. Others may use the abdomen for morning injections and the thigh or some other area for evening injections. Talk the doctor or diabetes educator about the best options for your child.

• If you inject in the arm, use only the outer back area of the upper arm (where the most fat is). Otherwise, you run the risk of injecting into a muscle.

• If you inject in the thigh, use only the top and the outside area. Stay away from the inner thighs—rubbing between the legs can make the injection site sore.

• If you inject in the abdomen, don’t do it too near the navel. The tissue there is tougher and makes the insulin absorption less predictable.

Sometimes, your child can develop lipohypertrophy even if you rotate sites. If the skin around an injection site(s) begins to look lumpy, stop using that site and consult the doctor.

Good insulin care begins with how the insulin is stored. Insulin does not work well when it’s kept for too long or is exposed to extreme temperatures. If you buy several bottles of insulin at once, keep the unopened ones in your refrigerator. (Don’t put them in the freezer. Insulin clumps at temperatures below 36° F.) Before you open a new bottle, check the date printed on it. If it’s more than a month past that date, don’t use the insulin—it’s too old.

If your child uses up a whole insulin bottle in a month or less, keep the bottle you’re currently using at room temperature. It will stay fresh for up to month without refrigeration, as long as its temperature stays under 86° F. If you would rather keep all insulin in the refrigerator, make sure to warm up the insulin before injecting it. Cold insulin can make the shot uncomfortable. Draw up the right amount into the syringe, then roll the syringe gently between your hands until it feels warm. 

Always check the insulin before you use it. Rapid- and short-acting insulin should look clear. There should be no cloudiness, little bits floating in the liquid, or change in color. Intermediate- and long-acting insulin should look cloudy, but you should not see any large clumps floating around. If you see any of these signs, discard the bottle.

Throwing out syringes is a little more complicated than pitching them in the nearest trash can. Needles can accidentally cut whoever takes out the trash or collects your family’s garbage. To protect others, it’s important to dispose of syringes carefully.

An easy way to get rid of used syringes is to put them in a heavy-duty plastic or metal container with a tight-fitting lid. An empty laundry detergent with a tight-fitting lid should do the trick. Or ask your child’s doctor or diabetes educator what containers they recommend. If you go this route, just put the used syringes in the container. Lancets should also be put in this container. When the container is full, put the lid on securely and throw the whole thing in the trash.

You can also buy a "safe-clip," which clips the needle off the syringe and stores the needles safely. You can find safe-clips at any pharmacy. Once the needle’s off, you can safely toss the rest of the syringe into the trash. But don’t try to clip needles off with scissors: they can send the needle flying across the room.

When your child is away from home, he should keep used syringes and lancets until they can be disposed of properly. He (or you, if the trip involves the whole family) can carry a metal or hard plastic pencil box to keep the syringes in until he gets home.

Some areas of the country have laws about disposing of medical waste. Call the local health department and find out about the laws where you live.

Nobody’s perfect. Everyone (parents and children) can make a mistake or run into a problem with insulin injections. Here are a few common problems and ways to handle them.

Too much insulin. If your child receives too much insulin, test his blood sugar about every two hours for the rest of the day or night. If you can determine how many extra units were injected, give the right amount of food to cover the extra amount. (For more on eating, go to Chapter 4.) Watch for symptoms of low blood sugar, and treat the symptoms promptly.

Too little insulin. If you know right away (within one hour) that your child didn’t receive enough insulin, just add another shot with the rest of the dose. If you don’t realize it until later, watch blood sugar and ketone levels for the rest of the day. (For more on ketone levels, turn to Chapter 6.) If your child’s ketone level is normal, encourage him to get some extra exercise.

Leaking from injection site. Sometimes insulin leaks out after an injection. If this happens, check blood sugar levels a little more often for the day. Consult the doctor about when and how to adjust a later insulin dose if blood sugar is higher than usual. If your child experiences leaking frequently, try one or all of the following tips to prevent leaking. For more suggestions, talk to the doctor.

• Push the plunger more slowly while injecting the insulin.

• Count to 5 or 10 after pushing in the plunger and before removing the needle.

• Check the angle of the needle. You may need to straighten it a little (to a 90° angle).

• Check the injection site for lumpiness. If it’s lumpy, choose another site.

Not feeling well. If your child feels woozy, moody, or tired for no apparent reason, his blood sugar level could be the culprit. To find out, check his blood sugar. (For a step-by-step guide to blood sugar testing, go to Chapter 6.) If it’s too low (hypoglycemia), he should eat or drink something with 10 to 15 grams of carbohydrates right away. When he starts to feel better, give him a snack high in carbohydrates. If blood sugar is too high (hyperglycemia), you may want to encourage him to plan some extra exercise. If your child’s blood sugar is too high on a regular basis, talk to the doctor about making some changes in his diabetes care. Also, keep in mind that getting sick—even with a cold—can make blood sugar levels unpredictable. (For more on hypoglycemia and hyperglycemia, turn to Chapter 6. For more on sick days, see Chapter 12.)

As your child grows, his diabetes care will grow with him. Over the years, he may need additional injections, changes on insulin dose, a new meal plan, or even a different insulin delivery system.

Why so many changes? For one thing, diabetes is different for everyone. Some children with diabetes can maintain good control on two shots a day. Others may need four shots a day. It can take some time to discover the best insulin schedule for your child. As he grows, he will need to eat more, which means that he will probably need more insulin to handle his increased food intake. And any time your child’s life changes, his diabetes treatment may need to change. For example, if he joins the basketball team, he’ll have to fit his shots and snacks around games and practices.

At times, you may feel that your child’s treatment is not working as well as it should. He may develop consistently high blood sugar levels or have extreme swings from lows to highs. Or it may be difficult to fit certain aspects of diabetes care into his schedule. Whatever the problem, don’t let it get out of hand. Talk with your child and his doctor or diabetes educator about possible changes in diabetes care that could improve his control.

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