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INSULIN INJECTION 

KNOW-HOW


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american association of diabetes educators 

Supported by BD Diabetes Care

1

Congratulations for making the move to 



insulin therapy. It won’t be long before you 

start enjoying better blood sugar control, 

more energy, and a host of other benefi ts.

The prospect of taking insulin 

injections may have you feeling a 

bit anxious. That’s OK! Just 

about everyone feels that way. 

Just know that your anxiety will 

vanish soon enough. Here are 

some valuable facts and tips to 

help make your transition to 

insulin smooth and easy.



WaYs to give insULin

Because insulin is broken down 

by digestive enzymes, it cannot 

be taken in pill form. Instead, it is 

delivered with a syringe into the 

layer of fat below the skin, also 

called the “subcutaneous” tissue. 

The layer of fat on the stomach, 

hips, thighs, buttocks and backs of 

the arms are common sites for 

injecting insulin. From there, the 

insulin absorbs into the blood-

stream where it circulates to the 

cells throughout the body. 

The really good news about deliver-

ing insulin into the layer of fat 

below the skin is that there are no 

nerve endings in this area, 

so injections are usually 

painless. There are a num-

ber of options for adminis-

tering insulin:

SYRINGES

Disposable plastic insulin 

syringes are still widely 

used, but the popularity 

of pens and pumps (see 

next page) is growing. 

Syringes vary in terms of 

how much insulin they hold as well 

as the length and thickness of the 

needle. Syringes can be used to 

deliver insulin directly into the layer 

of fat below the skin, or they can 

inject insulin into a temporary 

“port” that sits on the skin. The 

port, which is changed every 2-3 

days, features a small fl exible 

plastic tube that sits below the skin. 

A needle is used to place the tube 

under the skin, so only one needle 

stick is required every 2-3 days 

when a port is used.

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INSULIN INJECTION 

KNOW-HOW


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Learning how to inject insulin

Supported by BD Diabetes Care

2

American Association of Diabetes Educators 



insulin injection

know-how

learning how to

inject insulin

2

PENS



Insulin pens got their name because 

they are about the size and shape 

of a writing pen. They contain 

insulin (instead of ink) and have a 

dial for setting the dose. A dispos-

able pen needle is attached 

to the  end of the pen prior 

to injecting. As was the case 

with syringes, pen needles 

are available in a variety of 

lengths and thicknesses. 

Because they cut down on 

medical waste and are 

considered by most to be 

more convenient, accurate 

and easy to use than 

syringes, insulin pens are 

growing in popularity

among people of all ages.

PUMPS


Insulin pumps are electronic 

devices that are worn continuously 

and deliver insulin into the fat layer 

below the skin by way of a fl exible 

plastic tube (similar to the “port” 

described above). Insulin pumps are 

popular among those who require 

multiple daily injections of insulin. 

Safe and successful use of a pump 

requires considerable education 

and training, and their cost can be 

relatively high. Insulin pumps are 

not typically used by those who are 

new to insulin, but can be an eff ec-

tive option once you have a bit 

more experience.



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INSULIN INJECTION 

KNOW-HOW


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INSULIN INJECTION 

KNOW-HOW


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Supported by BD Diabetes Care

3

American Association of Diabetes Educators 



insulin injection

know-how

learning how to 

inject insulin

3

Choosing an injeCtion 



deviCe

The decision to use syringes or 

pens is a personal one. If you have 

an opportunity to sample both at 

your healthcare provider’s office, 

certainly do so. It is best to speak 

with your healthcare provider and 

check with your health insurance 

to find out what is covered under 

your plan.

Most pens hold 300 units of insulin 

and allow delivery of up to 60 to 80 

units at a time. “Prefilled” dispos-

able pens deliver in single-unit 

increments. “Durable” pens utilize 

replaceable/ insulin cartridges, and 

may deliver insulin in 1/2 unit incre-

ments. Pens can be used to deliver 

a variety of long-acting and rapid-

acting insulin types, as well as 

premixed insulin formulations. 

Disposable syringes hold up to 100 

units per injection. If you decide to 

use syringes, select a type that 

holds enough to cover your largest 

dose with a little room to spare. The 

markings on a syringe allow dosing 

in 2-unit, 1-unit, or 1/2-unit incre-

ments. Once you have a size that 

meets your needs, select a type 

that allows you to dose as precisely 

as possible.

The needles on syringes vary as 

well. Syringe and pen needles as 

short as 4mm and as long as 12.7mm 

are available. Thickness is measured 

in gauge. The higher the gauge, the 

thinner the needle. Gauges as high 

as 32 and as low as 28-gauge can 

be obtained. In general, it is best to 

use the shortest, thinnest (highest 

gauge) needles available. Skin 

thickness doesn’t vary much from 

person to person. Even if you are 

overweight or obese, it is unlikely 

that you will need a needle longer 

than 6mm. Needles that are too 

long may produce painful intra- 

muscular injections, with insulin 

absorbing faster than it should. 



Supported by BD Diabetes Care

4

American Association of Diabetes Educators 



insulin injection

know-how

learning how to

inject insulin

4

to dRaW one tYPe oF insULin 



into a sYRinge:

 

Ã



 

gather your insulin supplies: 

Get your insulin vial and a fresh 

syringe. Check the insulin vial to 

make sure it is the right kind of 

insulin and that there are no 

clumps or particles in it. Also 

make sure the insulin is not 

being used past its expiration 

date.

 

Ã



 

gently stir intermediate or 

premixed insulin: Turn the 

bottle on its side and roll it 

between the palms of your 

hands. Clear (fast-acting, long-

acting) insulin generally does 

not need to be mixed.

 

Ã

 



Prepare the insulin bottle: If 

the insulin bottle is new, remove 

the cap. It is not necessary to 

wipe the top of the bottle with 

alcohol as long as it is clean. 

 

Ã



 

Pull air into the syringe: 

Remove the cap from the 

needle. Pull back the plunger

on the syringe to draw in an 

amount of air that is equal to 

your insulin dose. The TIP of

the black plunger should

correspond to the number

on the syringe. 

 

Ã



 

inject air into the vial: Hold 

the syringe like a pencil and 

insert the needle into the 

rubber stopper on the top of 

the vial. Push the plunger down 

until all of the air is in the bottle. 

This helps to keep the right 

amount of pressure in the bottle 

and makes it easier to draw up 

the insulin.

 

Ã

 



draw up the insulin into the 

syringe: With the needle still

in the vial, turn the bottle and 

syringe upside down (vial above 

syringe). Pull the plunger to fi ll 

the syringe to the desired 

amount. 


 

Ã

 Check the syringe for air 



bubbles: If you see any large 

bubbles, push the plunger until 

the air is purged out of the 

syringe. Pull the plunger back 

down to the desired dose.

 

Ã



 

Remove the needle from the 

bottle: Be careful to not let the 

needle touch anything until you 

are ready to inject!

INJECTION TECHNIQUE 

Technique is everything when it comes to 

making insulin injections easy. 



INSULIN INJECTION 

KNOW-HOW


0-

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Supported by BD Diabetes Care

5

American Association of Diabetes Educators 



insulin injection

know-how

learning how to

inject insulin

5

When CoMBining tWo tYPes 



oF insULin (inteRMediate 

and RaPid) in the saMe 

sYRinge:

 

Ã



 gather your insulin supplies: 

Get your insulin vial and a fresh 

syringe. Check the insulin vial to 

make sure it is the right kind of 

insulin and that there are no 

clumps or particles in it, and 

that the expiration date has not 

passed.


 

Ã

 gently stir intermediate or 



premixed insulin: Turn the vial 

on its side and roll it between 

the palms of your hands. Clear 

(fast-acting, long-acting) insulin 

generally does not need to be 

mixed.


 

Ã

 



Prepare the insulin vials: If the 

insulin vial is new, remove the 

cap. It is not necessary to wipe 

the top of the bottle with 

alcohol as long as it is clean. 

 

Ã



 

inject air into the intermedi-

ate insulin vial: Remove the 

cap from the needle. With the 

vial of insulin below the syringe, 

inject an amount of air equal to 

the dose of intermediate insulin 

that you will be taking. Do not 

draw out the insulin into the 

syringe yet. Remove the needle 

from the vial.

 

Ã



 inject air into the rapid-

acting insulin vial: Only inject 

an amount equal to the rapid-

acting insulin dose. Leave the 

needle in the vial.

 

Ã

 



draw up the rapid-acting 

insulin: With the needle still in 

the vial, turn the vial upside 

down (vial above the syringe) 

and pull the plunger to fi ll the 

syringe with the desired dose. 

 

Ã



 

Check the syringe for air 

bubbles: If you see any large 

bubbles, push the plunger until 

the air is purged out of the 

syringe. Pull the plunger back 

down to the desired dose.

 

Ã



 

Remove the needle from the 

vial: Recheck your dose.

 

Ã



 

draw up the intermediate-

acting insulin: Insert the 

needle into the vial of cloudy 

insulin. Turn the vial upside 

down (vial above syringe) and 

pull the plunger to draw the 

dose of intermediate-acting 



INSULIN INJECTION 

KNOW-HOW


0-

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Supported by BD Diabetes Care

6

American Association of Diabetes Educators 



insulin injection

know-how

learning how to

inject insulin

6

insulin. Because the short-



acting insulin is already in the 

syringe, pull the plunger to the 

total number of units you need. 

Do not inject any of the insulin 

back into the vial, since the 

syringe now contains a mixture 

of intermediate and rapid-

acting insulin.

 

Ã

 Remove the needle from the 



vial: Be careful to not let the 

needle touch anything until you 

are ready to inject!

PRePaRing a Pen FoR 

injeCtion:

 

Ã



 Check the pen: Ensure that it 

contains the proper type of 

insulin and contains enough to 

cover your full dose. Also check 

to make sure that the expiration 

date has not passed.

 

Ã

 



gently stir intermediate or 

premixed insulin: Turn the

pen on its side and roll it 

between the palms of your 

hands. Clear (fast-acting,

long-acting) insulin generally 

does not need to be mixed.

 

Ã

 



attach a fresh pen needle: 

Screw or click the needle 

securely in place according to 

the manufacturer’s instructions. 

Remove the cap(s) from the pen 

needle to expose the needle.

 

Ã

 Prime the pen: Pointing the 



needle up in the air, dial one

or two units on the pen and 

press the plunger fully with

your thumb. Repeat until a

drop appears.

 

Ã



 

dial your dose: Turn the dial

on the pen to your prescribed 

dose.

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INSULIN INJECTION 

KNOW-HOW


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Supported by BD Diabetes Care

7

American Association of Diabetes Educators 



insulin injection

know-how

learning how to

inject insulin

7

deLiveRing an injeCtion:

 

Ã

 select a site: Choose a spot on 



your skin that you can see and 

reach. It is important to not 

“overuse” any particular area of 

skin. See the information below 

on “rotating” injection sites.

 

Ã



 

Make sure skin is clean: It is 

generally not necessary to wipe 

the skin with alcohol before 

injecting. Those at a high risk of 

infection should discuss site-

preparation procedures with 

their healthcare team.

 

Ã



 Pinch the skin: Pinch a one-to-

two-inch portion of skin and fat 

between your thumb and fi rst 

fi nger.


 

Ã

 Push the needle into the skin: 

With your other hand, hold the 

syringe or pen like a pencil at a 

90-degree angle to the skin and 

insert the needle with one quick 

motion. Make sure the needle is 

all the way in. 

 

Ã

 inject the insulin: Let go of the 



skin pinch before you inject the 

insulin. Push the plunger with 

your thumb at a moderate, 

steady pace until the insulin is 

fully injected. If using a syringe

keep the needle in the skin

for 5 seconds. If using a pen, 

keep the needle in the skin

for 10 seconds.

 

Ã



 Pull out the needle: Remove at 

the same 90-degree angle at 

which you inserted the needle. 

Press your injection site with 

your fi nger for 5-10 seconds to 

keep insulin from leaking out. 

 

Ã

 Remove the needle: If using a 



pen, remove the needle from 

the pen by replacing the large 

cover and unscrewing. Leaving 

the needle on the pen can 

result in leakage or air bubbles. 

 

Ã



 

dispose of your used needle: It 

is important to protect yourself, 

your loved ones, sanitation 

workers and pets from acciden-

tal needle sticks. Do not recap 

syringes before throwing them 

away. Place used syringes and 

pen needles in a thick plastic 

container (sharps container, 

detergent bottle, etc.). When 

nearly full, close the container 

tightly with a screw-on cap and 

tape closed. Dispose according 

to standards set forth by your 

local department of sanitation.

ABDOMEN


THIGHS

BUTTOCKS


ARMS

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ABDOMEN


THIGHS

BUTTOCKS


ARMS

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Correct (left ) and incorrect (right) ways of performing the skin fold.

the correct angle of injection 

when lift ing a skin fold is 90°

Supported by BD Diabetes Care

8

American Association of Diabetes Educators 



insulin injection

know-how

learning how to

inject insulin

8

ROTATING INJECTION 



SITES:

Insulin is injected into the fat layer 

below the skin on the abdomen 

(staying two fi ngers or a few inches 

away from the belly button), outer 

thighs, hips, buttocks, or backs of 

the arms. Although insulin injec-

tions are usually painless, injecting 

the same spot repeatedly can cause 

infl ammation or fat tissue break-

down. Lipodystrophy, as this is 

called, can cause lumps/swelling 

and thickened skin, and it may keep 

insulin from absorbing properly. 

Nearly half of all people who take 

insulin develop lipodystrophy, 

particularly when injection sites are 

not rotated properly.

Most forms of rapid and long-acting 

insulin absorb consistently from just 

about any body part, so feel free to 

use a variety of body parts for your 

injections, and use a variety of 

spots within each body part.

Intermediate-acting (cloudy)

insulin and premixed insulin absorbs 

diff erently in diff erent body parts. It 

is best to inject intermediate-acting 

insulin into one part of the body 

consistently, but use a variety of 

spots within that body part.

needLe Re-Use

Use of a new, fresh syringe or pen 

needle for each injection is the best 

way to minimize discomfort and 

ensure the accuracy/eff ectiveness 

of the insulin dose. Using someone 

else’s needle puts you at danger of 

contracting Hepatitis and HIV. 

ABDOMEN

THIGHS


BUTTOCKS

ARMS


1

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2

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ABDOMEN


THIGHS

BUTTOCKS


ARMS

1

6

11

2

7

12

3

 8

13

4

9

14

5

10

15

5

6

15

4

7

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3

 8

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2

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1

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ABDOMEN


THIGHS

BUTTOCKS


ARMS

1

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11

2

7

12

3

 8

13

4

9

14

5

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15

5

6

15

4

7

14

3

 8

13

2

9

12

1

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Recommended way to rotate 

injection sites.

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