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Glucose is the fuel the body takes from food for energy. This fuel is burned using insulin. When your child has diabetes, your child’s body isn’t making the insulin it needs. Without it, your child will not have energy. So the missing insulin must be replaced. Insulin can’t be taken by mouth because stomach acids will destroy it before it reaches the bloodstream. So insulin must be injected into the body. At first, injecting insulin may seem scary for both you and your child. But you will have help from your child’s healthcare team. They will teach you how to give your child insulin injections. If your child is older and independent, he or she may want to take control of injections. If so, you will still have to monitor to make sure he or she injects the correct amount of insulin.
There are many types of insulin. Here are types your child will use:
Fast-acting insulin. Fast-acting insulin must be taken with meals. Give it to your child within 15 minutes before your child eats.
Intermediate-acting insulin. Intermediate-acting insulin takes longer to start working than fast-acting insulin. But it stays in your child’s bloodstream longer.
Long-acting insulin. Long-acting insulin is in your child’s bloodstream at all times. It helps keep his or her blood sugar levels within target range for long periods.
Sometimes different types of insulin are mixed together and taken at the same time. Your child’s healthcare team will tell you what’s best for your child.
How fast insulin starts working depends on where you inject it. Insulin is used by the body best when it’s injected into the fat just below the skin. It works quickest when injected into the abdomen because there is more fat there than in other areas of the body. (Inject into the abdomen when you need to bring down high blood sugar.) Other injection sites include the upper back part of the arms, the buttocks, and the top and outer sides of the thighs. Other things to keep in mind when choosing the injection site include:
Change the injection site each time to avoid skin problems.
Have an organized way of knowing where you last injected. Use all the sites in the same area before moving on to the next. Ask your child’s healthcare team to show you how to do this.
Leave about 1 inch between injection sites.
Don’t inject in the area 2 inches around the belly button.
Do not inject into broken or scarred skin. And do not inject into moles or broken blood vessels (purplish bruises).
Don’t inject into a limb that your child will use for exercise. For example, don’t inject into a runner’s legs because the insulin will absorb too quickly when he or she exercises.
ALWAYS test your child’s blood sugar before injecting insulin. Blood sugar readings help you decide how much insulin to give. When injecting insulin, be sure to inject it into the fat just under the skin. Most people with diabetes inject using a syringe. Follow these steps for injecting insulin with a syringe:
Step 1: Getting ready
Gather your supplies. You’ll need:
A new syringe
Special container to throw out the used syringe (sharps container). You can buy a sharps container at a drugstore or medical supply store. You can also use an empty laundry detergent bottle, or any other puncture-proof container and lid.
Wash your hands. Use soap and warm water.
Clean the insulin bottle. Wipe the rubber stopper with an alcohol wipe.
Prepare the insulin. If your child uses cloudy-type insulin, roll the bottle gently between your hands about 20 times. Do not shake the insulin. And avoid using cold insulin. Instead, keep one bottle at room temperature and store the rest in the refrigerator.
Step 2: Preparing the syringe
Remove the syringe from its package.
Take the cap off the needle.
Draw air into the syringe. Pull back the plunger to draw air into the syringe. Pull the plunger back to the mark (line) for the number of units of insulin you want to inject. NOTE: the mark on the syringe barrel nearest the needle is 0 (not 1).
Inject air into the insulin bottle. Hold the bottle on a flat surface with one hand. With your other hand, hold the syringe straight up and down. Slowly push in the plunger to inject air into the bottle. (Injecting air makes it easier to draw out the insulin.)
Turn the syringe and bottle upside down. Keep the needle in the stopper. Flip the syringe and bottle so that the bottle is now on top and the syringe is on the bottom. Be careful not to bend the needle when tipping the insulin bottle.
Draw insulin into the syringe. Keep the tip of the needle below the level of insulin in the bottle. You may need to pull the needle out slightly. (This is to keep air from entering the syringe.) Slowly pull back the plunger to draw in the number of units of insulin you want to inject.
Check for air bubbles. Gently tap the syringe while the needle is still in the stopper. The air bubbles will move to the top of the syringe. Push the plunger in a tiny bit to release the air bubbles back into the insulin bottle. (Another way to release air bubbles is to slowly push all the insulin back into the bottle and then redraw the entire amount. This time, pull back the plunger even more gently to avoid air bubbles.)
Remove the needle from the insulin bottle.
Step 3: Giving the injection
Clean the injection site. Use an alcohol wipe to clean off the area of skin you’re going to inject. Allow the area to air-dry. If the skin is wet with alcohol the injection will sting.
Pinch an inch of skin. Pull up about 1 inch of skin. Pinch the skin gently. Don’t squeeze it. This is to ensure you don’t inject into muscle. Injecting into muscle is painful.
Insert the needle. Insert the needle into the skin, as directed by your child’s healthcare team. Hold the needle at the angle you were shown. Push the needle in until you can’t see it anymore.
Inject the insulin. Slowly push in the plunger until the syringe is empty. Count to 5 before pulling out the needle.
Step 4: Removing the needle
Remove the needle from the skin.
Watch the injection site for insulin leakage and blood. If the site bleeds, dab it with a cotton ball or tissue. If insulin leaks, ask your child’s healthcare team to check your injection technique at your child’s next visit.
Step 5: After the injection
Put the syringe in a sharps container. Don’t lay it down anywhere. And don’t recap the needle. Never throw out a syringe in the regular garbage. Someone taking out the trash or picking it up from your house could be stuck by the needle.
Be sure your child eats within 15 minutes of injecting fast-acting insulin (the kind used before meals).
Injection pens are also used to give insulin. They make it easier to measure the insulin and prepare the shot. It’s for this reason that pens are most often used when the child is away from home. Injection pens look like pens used for writing. Just like a regular pen holds ink, insulin pens hold insulin in cartridges. A new needle is screwed onto the pen each time you give an insulin injection. When you give the shot, insulin comes out of the tip of the needle just like ink comes out of a pen when writing. There are different kinds of insulin pens. Your child’s healthcare team will tell you which is best for your child. Pens also come with detailed manufacturer’s instructions for you to follow.
Wash your hands and clean the injection site with soap and water or alcohol pad before injecting. This helps keep the site from getting infected.
Use a new needle each time.
Never leave the needle on the insulin pen when you’re not using it.
Before injecting, tap the needle with your fingertip to get rid of air bubbles. Then test the pen by pressing the injection button all the way. Insulin should come out of the needle when you do this. If not, check for air bubbles again. Then test again. If no insulin comes out after three tries, start over with a new needle.
Push the button down all the way. Then count to 10 while injecting the insulin (pens take longer than syringes to deliver insulin).
Insulin must be kept cool for it to work properly. Store unopened bottles in the refrigerator. An open bottle can be stored at room temperature (such as on the kitchen counter). But don’t let the insulin get too hot. Always keep it below 86°F. And never let it freeze!
Each insulin bottle has an expiration date. Always throw away insulin that’s past its expiration date, whether or not you’ve opened it yet. (This is because old insulin may not work as well.)
In addition to having an expiration date, insulin must be used within 28 days of opening the bottle. Write the date you opened it on the bottle, as a reminder. Even if you haven’t used it up, after 28 days throw it away and open a new bottle.
Make sure your child carries his or her insulin and injection supplies in an insulated bag when away from home.
If you have any questions about how to use or store insulin, ask your child’s healthcare team.
Injections may be hard for both you and your child. But there are things you can do to make it easier. To calm your child’s fears:
Treat injections as normal and routine.
Praise your child for not delaying or making excuses. If your child needs to complain, give him or her time for that after the injection is over.
If your child has a severe fear of needles, talk to his or her healthcare team. They can help you find devices that make injections less scary for your child.
You never want to force your child to give himself or herself injections. Let your child tell you whether he or she is ready. As your child gets older, he or she may want to help with injections. Just make sure it is his or her decision to give injections. Help your child learn about giving injections by letting him or her:
Figure out how much insulin to take.
Choose the injection sites.
Draw insulin into the syringe.
Push on the plunger to inject the insulin.
Practice injections on an orange.
Ask your child’s healthcare team about devices that block your child’s view of the needle.
Keep skin healthy by changing injection sites each time. Doing so keeps the skin from scarring, which makes it harder for insulin to work properly. Also, never inject into moles, cuts, scars, or broken blood vessels (purplish bruises).
Ask your healthcare provider about giving yourself a test injection with sterile saline to experience how an injection feels.
For more information about diabetes, visit these websites:
American Diabetes Association www.diabetes.org
Children with Diabetes www.childrenwithdiabetes.com
Juvenile Diabetes Research Foundation www.jdrf.org
NOTE: This sheet does not give all the information you need to care for your child with diabetes. Ask your child’s healthcare team for more information.