- Diabetes injections are easier and less painful than ever, thanks to thinner needles and insulin pens.
- Know which areas on your body are best for injecting each type of medication - and why it’s so important to choose a different spot each time.
- Insulin and other diabetes medications are delicate! Careful handling helps to make sure they work as expected.
If you live with diabetes, injected medication may be part of your treatment plan. Since insulin was discovered in Canada in 1921, it has both saved and improved the lives of people with type 1 and type 2 diabetes. When other injectable medications became available in Canada in 2010, people with type 2 diabetes gained more options to control their condition. Thanks to thinner and shorter needles, diabetes injections have never been easier or less painful.
A pen injection device can make injections much simpler than using vials and syringes. Pens have the added advantage of being less noticeable while in public. If you currently use syringes for insulin injection, talk with a member of your diabetes team about the possibility of using an insulin pen.
Brushing up on your injection technique may help to make the process more comfortable and effective. Your diabetes health care team, including your pharmacist, are your best source of information about how to inject these medications.
Steps for insulin injection
- Wash your hands with warm water and soap.
- Wipe the rubber seal on the top of the vial or pen with an alcohol swab.
- If you use cloudy insulin, such as NPH or premixes, gently mix it to suspend the insulin before an injection. Roll the vial or pen between your hands 10 times horizontally, then tip from end to end at least 10 times, to get an even mixture. However, do not shake the vial or pen too hard. This can damage the insulin.
- If you use an insulin pen, put on a new pen needle every time. Next, set the dial to two units of insulin and shoot it into the air. This removes any air from the pen and checks that your pen and needle are working. Now, set the dial to the dose that you need.
- If you are using a syringe, first inject the same amount of air as your insulin dose into the vial while it is right-side up. With the syringe still in the vial, turn the bottle upside down, and draw up about five units of insulin. Push this insulin back into the bottle to get rid of any small air bubbles. Do this once or twice, until you can see that there are no bubbles. Draw your insulin dose into the syringe.
- When using a 4 mm pen needle (the size recommended for most people), insert the needle straight in at a 90 degree angle, without pinching up a fold of skin. If you use a longer pen needle (5, 6 or 8 mm) or a syringe, you may need to pinch up a fold of skin to avoid injecting into your muscle. Your diabetes team can advise you on the best needle option and injection technique.
- Inject all of the insulin, then keep the needle in the skin for 10 seconds before removing it.
Pen needles and syringes should be used once only. Immediately after the injection, remove the pen needle from the insulin pen and put it in a sharps container. Used syringes also belong in a sharps container. Once the container is full, close it securely. Take it to your nearest Safeway, Sobeys, Thrifty Foods, Foodland, Freshco or Lawtons pharmacy for appropriate disposal and replacement with a new container. Ask your pharmacist for details.
Injecting other diabetes medications
GLP-1 receptor agonists are daily or weekly injections used to treat type 2 diabetes. These brand names are Ozempic, Trulicity, Bydureon, Victoza, Byetta, and Mounjaro.
Combinations of GLP-1 receptor agonists and long-acting insulin are daily injections, also used for type 2 diabetes. These brand names are Soliqua and Xultophy.
Most medications are supplied in a different pen device except Mounjaro which is currently available in Canada in single-use vials.
The procedure to inject these medications is similar to injecting insulin. However, there are a few differences.
- Mounjaro needs to be drawn up from a single-use vial with a syringe. First inject 0.5 mL of air into the vial while it is right-side up. With the syringe still in the vial, turn the bottle upside down, and draw up a small amount of Mounjaro (if using an insulin syringe, about 5 units). Push this Mounjaro liquid back into the bottle to get rid of any small air bubbles. Do this once or twice, until you can see that there are no bubbles. Draw up 0.5 mL (or 50 units if using an insulin syringe) into the syringe. There will be a small amount of liquid left in the vial as they contain 0.7 mL to make it easier to draw up the required 0.5 mL. This small amount is meant to be discarded. Please consult your diabetes team/pharmacist for training and syringe/needle recommendations.
- Only Bydureon has a mixing procedure. Please consult the product instructions.
- Each product in a pen requires a different procedure to prepare the pen. Some require a small amount of liquid to be shot into the air each time. Others only require this step when first starting a new pen. Some do not require this step at all. You can find the details about preparing your pen in the product instructions. Ask your pharmacist for help if needed.
- Some products use the same pen needles as insulin. Others include the needles in the package. Please discuss this with your pharmacist.
Carefully choose the place for the injection
Diabetes medication is best injected into one of three areas of the body:
- the abdomen
- the top and outer thighs
- and the back of the upper arms.
These sites all have a layer of fat under the skin (called subcutaneous fat) that allows diabetes medication to be properly absorbed by the body. The back of the upper arm is a difficult area to self-inject, and so should only be used when another person is giving the injection. The buttocks contain subcutaneous fat, and so insulin can be injected here as well. However, injections of other diabetes medications in this area are not recommended.
Heat and massage can affect how quickly insulin is absorbed. Avoid injecting insulin after a sauna or hot bath, and do not massage the area after the injection, as this can cause insulin to be absorbed more quickly.
Scars, moles, or the navel (belly button) absorb insulin poorly. Do not inject within five centimeters (two inches) of these areas.
Rotate diabetes injection sites
If insulin is injected into the same spot over and over, fat can build up under the skin. This lump of fat, called lipohypertrophy, may interfere with the insulin being absorbed properly. You could experience unexplained high or low blood glucose as a result. To prevent lipohypertrophy, choose a different spot to inject each time.
Each injection should be about two centimeters (the width of one finger) away from the previous one. Your diabetes team can provide you with a diagram explaining the most effective way to use an entire area, such as your abdomen or thighs, for injections.
Ask your diabetes team to check your areas of injection regularly for lipohypertrophy. You should also learn how to detect it on your own. If such an area is found, avoid injecting there. With time, the fat buildup under the skin will be absorbed and the area can be used for injections again.
Although GLP-1 receptor agonists do not cause lipohypertrophy, it is still important to rotate injection sites when using these medications.
Recommended places for injection
Properly care for and store medications
Insulin and GLP-1 agonists are delicate. Special care must be taken to keep them safe. They should not be overheated, exposed to sunlight, frozen, or shaken roughly. Injectable diabetes medications that are not handled correctly can lose their effectiveness. Damaged medications may not be able to control blood glucose levels.
- Each multidose injectable diabetes medication is good for a certain number of days after opening. This will vary from 28 to 56 days, depending on the product. Please consult the product information.
- Once you open a multi-dose injectable diabetes medication pen or vial, keep it at room temperature. Injections will be more painful if the medication is cold.
- Store extra injectable diabetes medications in the refrigerator. Kept this way and unopened, they can be used until the expiry date. Always check the expiry date before you use a medication, and discard any that have expired.
- If required, Trulicity can be stored at room temperature for 14 days, Bydureon for 28 days, and Mounjaro for 21 days.
- If you plan to travel, discuss storage requirements with your pharmacist well ahead of your departure date.
- Medications that have been frozen, heated, or exposed to direct sunlight should be discarded.
For More Information
Diabetes Canada webinar, How to inject insulin – a step-by-step guide:
https://youtu.be/cHmdBMJe1Pg?si=z8j8lNsI_Crwp56Q
With education and practice, injectable diabetes medications can be used safely by anyone with diabetes. Regular review of your technique is a good idea. Members of your diabetes team, such as your diabetes educator or pharmacist, can help you to refresh your skills at your next visit.
WRITTEN BY: Rami Chowaniec, BScPharm, CDE, a pharmacist at Southgate Safeway in Edmonton, Alberta.
