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INSULIN INJECTION 

KNOW-HOW


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american association of Diabetes educators 

Supported by BD Diabetes Care

1

pro tips (and tricks) for easier and

better Insulin Injections

WHERE IS THE BEST PLACE TO GIVE INJECTIONS?

Insulin and other injected diabetes 

medications are meant to be deliv-

ered into the fat layer just under 

the skin. Popular injection sites 

include the abdomen (staying two 

fi ngers or a few inches away from 

the belly button), outer thighs, hips, 

upper buttocks, lower back, and 

backs of the arms. Modern insulin 

products are well absorbed and act 

about the same regardless of where 

they are injected. However, for best 

results it is important to stick with a 

consistent body part for your 

injections in order to avoid varia-

tions in insulin action. Ultimately, 

the choice is up to you. Select a 

part of your body that you can see, 

reach, and access easily. But be 

sure to use a number of diff erent 

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recommended injection sites

Supported by BD Diabetes Care

2

American Association of Diabetes Educators 



insulin injection

know-how

pro tips and 

tricks for easier

and better

insulin injections

2

spots within that body part. This is 



called “rotating” injection sites. 

Injecting into the same spot too 

oft en can cause skin problems and 

can impair insulin absorption. 

For example, if you choose to use 

your abdomen, rotate injection 

spots on a daily basis like these:

With this type of pattern, you’ll stay 

on the left  side of your abdomen for 

12 days and then switch to the right 

side for 12 days. That way, each spot 

has 24 days to “heal” before you 

use it again! Regardless of which 

body part and rotation pattern you 

choose, avoid spots on your skin 

that have scar tissue, moles, swell-

ing/infl ammation, or unusual 

changes in appearance or texture.

ABDOMEN

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BUTTOCKS

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recommended way to rotate injection sites.

Supported by BD Diabetes Care

3

American Association of Diabetes Educators 



insulin injection

know-how

pro tips and  

tricks for easier 

and better 

insulin injections

3

Do I have to keep my InsulIn 



refrIgerateD all the tIme?

Yes and no. Insulin is a large protein 

molecule that breaks down gradu-

ally when exposed to warm temper-

atures. It is best to keep your extra 

insulin and other injected diabetes 

medications refrigerated. However, 

once you begin to use a vial or pen, 

it is usually fine to keep it at room 

temperature for up to a month. Do 

not store your insulin near extreme 

heat (above 86°) or extreme cold 

(below 36°). (3) Never store insulin 

in the freezer, direct sunlight, or in 

the glove compartment of a car. 

All insulin vials and pens should be 

replaced monthly, if not more often, 

to ensure that they are working at 

full potency. Be sure to check the 

expiration date before opening the 

box, and do not use insulin past its 

expiration date without your physi-

cian’s approval. Examine the insulin 

closely to make sure it looks normal. 

Clear insulin should not have 

crystals or discoloration, and cloudy 

insulin should not have clumps or 

pieces stuck to the sides of the 

vial/pen.

Is there a trIck for 

rememberIng to take 

my InjectIons?

Missed injections (or taking injec-

tions much too late) can cause 

serious blood sugar control prob-

lems. Research has shown that 

missing just one insulin injection 

per week can raise your A1c by 

more than 0.5%!



here are some techniques for 

helping you to remember to take 

your injections:

 





 Attitude is important, so take 

your diabetes seriously! 

 



 Write down your injection doses 



after taking them

 





 Use reminder alarms on a watch 

or cellular phone

 



 Take your injection at the same 



time that you perform another 

daily ritual, such as taking oral 

medication or brushing your 

teeth 


 



 Keep your injection materials in 



a strategic location so that you 

notice them at the right times

 



 If you take insulin at mealtimes, 



take it before eating (with your 

doctor’s approval).  



pro tips and  

tricks for easier 

and better 

insulin injections

Supported by BD Diabetes Care

4

American Association of Diabetes Educators 



insulin injection

know-how

pro tips and  

tricks for easier 

and better 

insulin injections

4

 





 Inject your insulin at room 

temperature. Cold insulin has a 

tendency to sting. When using a 

pen or vial for the first time, 

take it out of the fridge a half 

hour early so that it has time to 

warm up to room temperature.

 



 Relax the muscles in the area 



where you are injecting. Tense 

muscles make the nerves in the 

area more sensitive.

 





 Pinch the area where you will 

inject so that the skin surface is 

hard. This ensures a quick, clean 

injection. A quick needle 

insertion causes the least 

amount of pain.

 



 If you clean your skin with an 



alcohol pad, wait until it has dried 

completely before you inject.

 



 Doses of 30 units or more may 



cause pressure to build up 

under the skin. Ask your physi-

cian if you can split large doses. 

 





 Avoid injecting into sensitive 

muscle by using a short needle 

(6mm or less). 

 





 Choose the thinnest needle 

possible. Remember, the 

higher the gauge, the thinner 

the needle. 



Is It necessary to mIx Insu-

lIn before InjectIng It?

In general, clear insulin does not 

need to be mixed before injecting. 

This includes Regular insulin, 

rapid-acting insulin analogs (aspart, 

lispro and glulisine) and long-acting 

basal insulin (glargine and detemir). 

However, any vial or pen that 

contains NPH — including premixed 

formulations such as 75/25 and 

70/30 — must be mixed until they 

are uniformly cloudy before inject-

ing. The best way to ensure an even 

mixture is to roll the pen or vial 

between your palms ten times, then 

inspect to make sure there are no 

“clumps” settling at the bottom. 

Injecting insulin that is not properly 

mixed can result is serious high or 

low blood sugar.



how can I keep the 

InjectIons from hurtIng?

In most cases, insulin injections hurt 

very little, if at all. However, there 

are a few things you can do to make 

the injections as painless as 

possible:

 



 Use fresh needles for each 



injection. Even after just one or 

two uses, syringe and pen 

needles can become dull. Sharp 

needles cause the least amount 

of trauma to the skin.


Supported by BD Diabetes Care

5

American Association of Diabetes Educators 



insulin injection

know-how

pro tips and  

tricks for easier 

and better 

insulin injections

5

4.



   After removing the needle, put 

mild pressure on the injection 

site (with a clean finger) for 

5-8 seconds.



Is It ok to throw my useD 

neeDles In the trash?

There are two things to consider 

when it comes to disposing sharp 

objects such as syringes, pen 

needles and lancets:

local ordinances

Every municipality has its own rules 

about the handling of medical 

waste. Check with your local 

department of sanitation for details. 

Each state also has established 

guidelines regarding sharps dis-

posal. The Centers for Disease 

Control (CDC) has more informa-

tion about safe needle disposal in 

your area: www.cdc.gov/

needledisposal.



the safety of those around you

Being a responsible person with 

diabetes means taking steps to 

ensure the safety of family, friends, 

domestic employees, sanitation 

workers and yes, even pets. Acci-

dental needle sticks can produce 

serious pain and infections. One 

way to protect those around you is 

to place your used syringes, pen 

needles and lancets in a non-clear 

heavy-duty plastic jug with a secure 

screw-on cap. Don’t bother recap-

 





 If pain persists despite using 

these techniques, try rubbing 

ice on your skin for a few min-

utes before injecting, or ask 

your doctor about using an 

injection port instead of inject-

ing directly into your skin.

what shoulD I Do If InsulIn 

leaks out after the 

InjectIon?

Occasionally, insulin may leak out of 

the skin after you remove the 

needle, even if you have left the 

needle in the skin for 5-10 seconds. 

Research has shown that the 

amount of insulin lost in these 

situations is usually minimal and will 

probably not affect blood sugar 

control. Unless large drops appear 

that run down your skin, you should 

not have to worry about replacing 

what is lost. 

However, to ensure accurate and 

consistent dosing, it is best to do 

what you can to prevent leakage. 

Here are a few tricks:

1.    


When injecting, release the 

“pinch” on your skin before 

pressing down on the plunger.

2.

   Keep the needle in your skin a 



few seconds longer than usual.

3.

   If leakage occurs often, insert 



the needle and inject at a 

45-degree angle rather than 

going straight into the skin.


Supported by BD Diabetes Care

6

American Association of Diabetes Educators 



insulin injection

know-how

pro tips and  

tricks for easier 

and better 

insulin injections

6

absorption/action and no increase 



in leakage back onto the skin 

surface. Glucose control does not 

suffer when switching from long to 

short needles, even in those who 

are obese. Needles that are too 

long can cause accidental injection 

into muscle, which alters the normal 

action of the medication and can be 

quite painful.

For these reasons, most healthcare 

organizations now recommend the 

use of shorter needles. Rarely is 

there a medical reason to use 

needles longer than 6mm. For 

those with a great deal of fat 

below the skin, use of short 

needles also eliminates the 

need to pinch the skin when 

administering the injection.

ping the needles… just throw them 

into the jug, and keep the jug in an 

out-of-the-way place. When the jug 

is full, seal the cap with strong tape 

and dispose according to local 

regulations (usually it is OK to just 

place in your normal trash). When 

traveling, bring a smaller container 

with you for your used items, and 

bring it home with you for safe 

disposal.

Another way to protect those 

around you is to purchase and use a 

device that clips, catches, and 

contains the needles. Do not break 

the needles off with your fingers, as 

you can easily stick yourself. And do 

not use scissors to clip off needles 

— the flying needle could hurt 

someone or become lost.

are longer neeDles better 

than shorter neeDles?

Good news! In almost all cases, 

shorter needles are better than 

longer ones. For insulin to work, it 

only needs to get into the fat layer 

below the skin. While the amount of 

fat varies from person to person, 

skin thickness tends to be about the 

same — around 2mm. So needles 

that are at least 4mm long do the 



job quite well, producing normal 


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