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Injection Sites

Assess each patient individually for suitable areas to inject. These include:

Recommend sites that are easiest to reach.

Rotate sites at each injection.

• Do not mix site and time, as each site has a different absorption pattern
• Advise patients to keep a consistent site for each time of day, which helps to reliably predict the effect of a dose of insulin.
• It is important however to rotate injections within the same site each day.

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INSULIN ADMINISTRATION DEVICES

Syringes Suitable for

• patients using two different insulin preparations that need to be mixed
• patients using large volumes of insulin which cannot be accommodated in a pen.
• patients whose injections are given by a 3rd party e.g. carer or Community Nurse.
• Insulins for use with syringes should be prescribed in vials.

1ml and 0.5ml syringes are available for use with standard length needles (12.7mm. 0.5ml and 0.3ml syringes are available in short length needles (8mm). Both are obtained on prescription

Pen Devices Many patients use a pen injector device for insulin self-administration. This is available in two forms, either a reusable form for use with a cartridge or a pre-filled (disposable) type. Both are available on prescription

• Pen devices are designed for self use only.
• The advantage of pen injection devices is the convenience of carrying and administering the insulin.
• Disposable (pre-filled) pens are particularly useful for patients who are not so dexterous.
• All cartridges for re-usable pens at present come in 3ml size. However a few patients receiving Porcine insulin (Hypurin preparations) use 1.5 ml cartridges

Pen needles are available on prescription. 8mm, 6mm or 5mm needles are recommended. Needles should be changed for each injection

Storage of Insulin and Pen Devices

• Insulin is stable at room temperature for 1 month
• Insulin vials should be stored in a fridge, but not in the freezer compartment
• Insulin pens that are "in use" may be kept at room temperature, but spare cartridges or disposable pens should be kept in a fridge.

GLUCOSE MONITORING EQUIPMENT

A wide variety of meters are available. Electrodes/test strips are not interchangeable for use between the various brands. Contact any of the Diabetes Specialist Nurses for further details and advice. Quality control solution is available from manufacturers. Lancets for finger pricking devices should be changed following each finger prick. Disposable lancets should be used by staff.

Continuous glucose monitors are devices that help people with Type 1 diabetes track their blood glucose levels over 3-6 days. This consists of a sensor worn under the skin that transmits information about the body's glucose levels to a receiver. The receiver displays frequently updated glucose readings and stores information about changes in glucose levels over time. CGMS devices can also be programmed to set off alarms when glucose levels become too low or too high.

Patient information leaflet on Continuous Glucose Monitoring.

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