Insulin Pens: Your pen comes with an instruction book. Please review it to understand how your pen works, how to load the cartridge, and how to prepare your pen for an insulin injection. Mixing Insulin

Insulin Pens: 

 

Your pen comes with an instruction book. Please review it to understand how 

your pen works, how to load the cartridge, and how to prepare your pen for an 

insulin injection.

Mixing Insulin:

Insulin that is cloudy (NPH, premixed) needs to be mixed before using.  

The pen should be rolled ten times, tipped ten times, and checked for a milky-

white consistency. 

Check Insulin Flow (Prime):

 

Attach pen needle. Dial up 2 units and, with pen tip facing upwards, push the 

dosing button. If no stream of insulin appears, repeat with another 2 units.

Giving Your Injection: 

 

After you have checked the insulin flow, dial up the dose of insulin to be taken. 

Insert pen tip into skin at a 90º angle. Push the dosing button until you see ‘0’. 

Count 10 seconds before removing the needle from your skin to ensure you 

receive the full dose. With longer needles (≥ 8mm), you may need to gently lift 

the skin before injection. 

Site

Pros

Cons

Abdomen (tummy)

•

  Stay 2 inches (5 cm) 

away from your belly 

button

Easy to reach

Insulin absorbs fast  and 

consistently

Buttock and thigh

Slower absorption rate 

than from abdomen and 

arm sites

Slower absorption

Absorption can be  

affected by exercise

Outer arm

After abdomen, arm 

provides the next fastest 

absorption rate

Harder to reach for  

self-injections

Getting started

with insulin

NOTE: It is really important to change 

(rotate) where you give yourself insulin 

to prevent fatty lumps from forming 

since these can affect how your body 

absorbs insulin. For example, you can 

move from one side of your abdomen to 

the other side, and you can also move 

your injection site to a different location 

within each side of your abdomen.

Avoid a 2-inch area around the belly 

button as well as scar tissue.

Insulin Injection Sites

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*This document reflects the 2013 Canadian Diabetes  Association Clinical Practice Guidelines. ©2013 Copyright

 

Insulin Care and Storage:

 

Unopened insulin should be stored in the fridge between 2ºC 

and 8ºC. Opened insulin can be stored at room temperature 

for up to 1 month. Insulin detemir (Levemir) is an exception; 

it is safe at room temperature for 42 days. Keep all insulins 

away from direct heat and light. Discard insulin that has been 

frozen or exposed to temperatures greater than 30ºC. Do not 

use insulin after its expiry date.

Diabetes Identification: 

You should always wear idenfication, such as a bracelet or 

necklace, to identify that you have diabetes. Identification 

bracelets, such as MedicAlert

®

, can be purchased at 

pharmacies and jewellery stores. Always carry identification  

in your wallet or purse that provides information about  

your diabetes.

Insulin Types: 

Type

Onset  

( How  quickly  it 

starts working)

Peak  

( When it is most 

effective)

Duration 

( How long it 

works)

Timing of injection 

( When should it be given)

Bolus insulins

Rapid acting analogues

•

  Apidra / Humalog /  

NovoRapid

10 – 15 min

1 – 2 hours

3 – 5 hours

Given with 1 or more meals per day. To be given 

0 – 15 minutes before or after meals.

Short-acting

•

  Humulin-R / Toronto

30 min

2 – 3 hours

6.5 hours

Given with one or more meals per day. Should 

be injected 30 – 45 minutes before the start of 

the meal.

Basal insulins

Intermediate-acting 

•

  Humulin-N / NPH

1 – 3 hours  

5 – 8 hours  

up to 18 hours

Often started once daily at bedtime. May be 

given once or twice daily. Not given at any time 

specific to meals.

Long-acting analogues 

•

   Lantus

•

   Levemir

90 min

not applicable

up to 24 hours

16 – 24 hours

Often started once daily at bedtime. Insulin 

detemir (Levemir) may be given once or twice 

daily. Not given at any time specific to meals

Premixed insulins

Premixed regular 

insulin

•

  Humulin 30/70 /  

Novolin ge 30/70, 

40/60, 50/50

Varies accord-

ing to types of 

insulin

contains a 

fixed ratio of 

insulin (% of 

rapid-acting 

or short-acting 

insulin to % of 

intermediate-

acting insulin): 

see above for 

information 

about peak 

actions based 

on insulin 

contained

Given with one or more meals per day. Should 

be injected 30 – 45 minutes before the start of 

the meal.

Premixed insulin  

analogues

•

  NovoMix 30 / Humalog 

Mix 25, Mix 50

Varies accord-

ing to types of 

insulin

Given with one or more meals per day. Should 

be injected 0 – 15 minutes before or after meals.

diabetes.ca | 1-800 BANTING 

*This document reflects the 2013 Canadian Diabetes  Association Clinical Practice Guidelines. ©2013 Copyright

 

Low Blood Sugars (Hypoglycemia):

Treatment of Low Blood Glucose (Hypoglycemia)

What is low blood glucose? 

When the amount of blood glucose (sugar in your blood) has dropped below your target range (i.e. is generally less than  

4.0 mmol/L), a condition called low blood glucose or hypoglycemia occurs.

When this happens, you may feel:

•

  Shaky, light-headed, nauseated 

• 

A faster heart rate

•

  Nervous, irritable, anxious 

• 

Sweaty, headachy

•

  Confused, unable to concentrate 

• 

Weak, drowsy

•

   Hungry 

• 

A numbness or tingling in your tongue or lips

How do I treat low blood glucose?

If you are experiencing the signs of a low blood glucose level, check your blood glucose immediately. If you do not have your 

meter with you, treat the symptoms anyway. It is better to be safe.

Eat or drink a fast-acting carbohydrate source (containing 15 grams). For example:

•

 15 g of glucose in the form of glucose tablets (preferred choice)

•

 15 mL (1 tablespoon) or 3 packets of table sugar dissolved in water

•

 175 mL (¾ cup) of juice or regular soft drink

•

 6 LifeSavers

®

 (1 = 2.5 g of carbohydrate)

•

 15 mL (1 tablespoon) of honey (do not use for children less than 1 year)

Low blood glucose can happen quickly, so it is important to treat it right away. If your blood glucose drops very low, you may 

need help from another person.

Causes of hypoglycemia:

•

 More physical activity than usual 

• 

Taking too much medication

•

 Not eating on time 

• 

Drinking alcohol

•

 Eating less than usual

Checking Blood Sugars and Adjustment of Insulin: 

Insulin:  

Starting Dose:  

units at

Blood glucose goals:

Contact for help with insulin adjustments:

What to do with your diabetes pills: 

Please check blood sugars using the following schedule.

Breakfast

Lunch

Supper

Bedtime

Night

before

after

before

after

before

after

Insulin

SMBG pattern*

* SMBG = self-monitoring of blood glucose

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*This document reflects the 2013 Canadian Diabetes  Association Clinical Practice Guidelines. ©2013 Copyright

 

Proper Use of Pen Tips (needles): 

Use pen tips only once; they are thin and can become bent or 

broken if re-used. Reusing pen tips can make the injection more 

painful. Leaving pen tips on the cartridge may cause leaking or 

allow air into the cartridge which may affect the concentration of 

the insulin.

Safe Sharps Disposal:

Pen tips and lancets should be disposed of in a sharps container. 

Check with your local pharmacy. Many pharmacies supply safe, 

puncture-proof containers. When the container is full, it  

is returned to the pharmacy in exchange for a new container. 

Sharps otherwise should be disposed of in accordance with  

local regulations.

Diabetes Driving Guidelines

Prevention of hypoglycemia for all insulin-treated 

drivers

•

  Measure your blood glucose level immediately before and at 

least every 4 hours during long drives. Always carry blood 

glucose monitoring equipment and treatment for hypoglycemia 

within easy reach (e.g. attached to the visor).

•

  You should not drive when your blood glucose level is less than 

4.0 mmol/L. You should not begin to drive without having 

some carbohydrate-containing food when your blood glucose 

level is between 4.0 – 5.0 mmol/L.

•

  Stop and treat yourself as soon as hypoglycemia and/or 

impaired driving is suspected. You should not drive for at least  

45 – 60 minutes after effective treatment of mild to moderate 

hypoglycemia (i.e. blood glucose level 2.5 – 4.0 mmol/L).

Professional Drivers must

•

  Carry supplies when you are driving:

•

  A blood glucose monitor

•

  A source of readily available, rapidly absorbable carbohydrate

•

  Test your blood glucose 1 hour before starting to drive and 

approximately every 4 hours while driving

•

  Stop driving if your glucose level falls below 6.0 mmol/L and do 

not resume driving until your glucose level has risen to  

6.0 mmol/L or higher following food ingestion

Each province has its own rules regarding glucose control and 

being able to drive. 

I want to apply for a commercial licence.  

Can I drive in Canada? In the United States? 

Canadians with diabetes who are using insulin can apply for a 

commercial licence. Motor vehicle licensing authorities require 

a greater level of medical fitness for drivers operating passenger 

vehicles (buses/commercial vans), trucks, and emergency 

vehicles. Commercial drivers spend more time driving and are 

often under more adverse conditions than private drivers. 

Canadians with diabetes who are using insulin can be licensed to 

drive a commercial vehicle in Canada. The Canada/US Medical 

Reciprocity Agreement (effective March 1999) recognizes the 

similarity between Canadian and American medical standards 

and provides for reciprocal arrangements on medical fitness 

requirements for Canadian and American drivers of commercial 

vehicles.

However, Canadian commercial drivers who have diabetes 

requiring insulin, have monocular vision, are hearing impaired, 

or have epilepsy requiring anticonvulsive medication are not 

permitted to drive in the United States. 

What is the Canadian Diabetes Association’s position on 

diabetes and driving and licensing? 

The Canadian Diabetes Association believes people with diabetes 

should be assessed for a driver’s licence on an individual basis.

http://www.diabetes.ca/get-involved/helping-you/advocacy/faq/

driving/ 

Adapted from Canadian Diabetes Association’s Clinical Practice Guidelines for 

Diabetes and Private and Commercial Driving. Canadian Journal of Diabetes. 

2003;27(2):128-140.

112002 04/13 

Across the country, the Canadian Diabetes Association is leading the fight against diabetes by 

helping people with diabetes live healthy lives while we work to find a cure. Our community-

based network of supporters help us provide education and services to people living with 

diabetes, advocate for our cause, break ground towards a cure and translate research into 

practical applications.

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*This document reflects the 2013 Canadian Diabetes  Association Clinical Practice Guidelines. ©2013 Copyright

Related articles: Lows and Highs: Blood Glucose Levels, Thinking of Starting Insulin, 

Managing Your Blood Glucose