Monday, March 6, 2023

Remember insulin.. Do not use insulin to get rid of it after the end of the period of validity of use



Remember insulin

Insulin administration


Insulin is injected under the skin.

Depending on the age of the child, either the parents give the injection, or they help the child, or they are present whenever possible.

Materials needed to inject insulin, you need either:


  • a refillable insulin pen with an insulin cartridge, a needle.
  • a pre-filled pen a needle.
  • an insulin syringe with a crimped (soldered) needle and insulin cartridges.
  • an insulin pump: a catheter, a reservoir, tubing depending on the model, a pre-filled pen, an insulin cartridge or vial, a needle.
 

Storage of insulin:


It is important to regularly check the expiry date on the insulin label.

Unproduced insulin vials, cartridges or pens can be stored in the refrigerator, crisper or top of the door.

The bottles, cartridges or pens produced should be kept outside the refrigerator, away from heat (no more than 25°) and the sun, maximum 1 month for most, sometimes 2 months for some.

You need to know how to distinguish between fast-acting insulins, which appear clear, and long-acting insulins: NPH, which appears cloudy, and ready analogues, which appear clear.

Before injecting "cloudy" insulins, turn the vial or pen several times to make the preparation homogeneous.

Storage of needles:


regularly check the expiry date on the box of needles.THE INSULIN PEN
The pen makes it easier to inject insulin than with a syringe. Insulin is available at all times in a refillable pen equipped with a cartridge or in a disposable pre-filled pen.

Refillable pens used with cartridges adapted to the pen, allow insulin to be selected by ½, 1 or 2 Unit(s).

Disposable pre-filled pens also allow you to select insulin by ½, 1 or 2 Unit(s), others only by 1 or 2 units.


To make the injection, you need special needles, which adapt to the pen used. Needles of different lengths exist: 4 mm needles are recommended in paediatrics.

The most suitable pen and needles are chosen with the healthcare team.

The pen is very practical but you can break it or lose it. so always have a spare.

How to prepare the insulin pen

There are various models of pens, cartridges and needles.

It is therefore necessary to refer to the user manual of each.

In general, if the pen is refillable: put the cartridge in the pen.

The disposable pre-filled pen is ready to use.

Inserting the needle on the pen:

Use a new needle for each injection, to ensure that the seal is intact

Use a new needle for each injection. Check that the cover is intact then remove it.
Approach the needle in the same axis as the pen.
Pierce the membrane of the pen with the internal needle, screw the needle completely onto the pen, avoiding over-tightening.
Remove the outer and inner cap.

Before each injection

We check that there is enough insulin left in the cartridge to inject the planned dose of insulin:

  • If there is not enough insulin, the cartridge or pen is changed.
  • Always perform a test to make sure the pen and needle are working properly: select 2 units of insulin (or more according to the package insert).
  • Purge 5 units if new cartridge or pen
  • Point the needle up. Press the push button until the selection returns to 0. Check in any case that a few drops of insulin appear. Repeat the operation if necessary.
  • Be careful, there may be adjustment errors: it is important to check that the selected dose corresponds to the decided dose.

THE INSULIN SYRINGE

Insulin syringes are graduated in units of insulin. Depending on the dose to be injected, we use:

0.3 ml syringes containing 30 units of insulin
0.5 ml syringes containing 50 units of insulin
1 ml syringes containing 100 units of insulin
The syringe takes either a single insulin or a mixture of fast-acting and long-acting insulin.

Attention ! Some slow analogs do not mix with the fast.

How to prepare the syringe with an insulin?

  • Note the dose of fast-acting insulin analog and that of long-acting (NPH) or slow-acting intermediate-acting analog. Calculate the total dose.
  • Wash your hands then prepare the vials of insulin, the cotton, the vial of alcohol and the insulin syringe.
  • Disinfect the caps of the insulin vials with an alcohol cotton ball at 70°.
  • After pushing the plunger all the way in, fill the syringe with a volume of air equivalent to the dose of long-acting insulin (NPH) or intermediate-acting slow analogue.
  • Expel the air from the vial of long-acting insulin (NPH) or slow-acting intermediate-acting analogue. Withdraw the needle without withdrawing the insulin.
  • Then fill the syringe with a volume of air equivalent this time to the dose of rapid analogue.
  • Expel air from the Rapid Analog vial.
  • Turn the vial-syringe assembly upside down and pull the plunger to withdraw a quantity of rapid analogue greater than the desired dose.
  • Tap the syringe to make air bubbles rise. If it is difficult to expel bubbles, remove the needle from the Rapid Analog vial and proceed as previously described.
  • Expel the air from the top of the syringe and adjust the rapid analog dose precisely.
  • Before injecting “cloudy” insulin, NPH, gently invert the vial (or pen cartridge) 10 times then roll it between the palms of the hands 10 times to make the preparation homogeneous.
  • Hold the syringe by the plunger to avoid any mixing of the insulins in the vial. Turn the vial of long-acting insulin upside down and insert the needle into the stopper.
  • Pull the plunger back slowly, without blowing bubbles, to draw up the desired dose of long-acting insulin.
  • Stop directly and exactly at the calculated total dose value, without re-injecting insulin into the vial.
  • Remove the needle from the vial and put the cap back on the needle.

How to prepare the syringe with 2 insulins


WHERE TO GET THE INSULIN INJECTION

The choice of injection site is dictated by the following facts:

  • The action of insulin varies from area to area.
  • Insulin action is influenced by muscle activity in the injection site.
  • If the injections are made too close to each other in the same area, there is a risk that bumps or depressions called lipodystrophies will form.
  • If we prick in lipodystrophies, we modify the action of insulin.

INSULIN INFUSION SITES ARE:

  • arm, belly, thigh and upper buttock.
  • Site in the arm: the back of the arm, upper part, 1 to 2 fingers below the shoulder.
  • Site in the belly: from one side to the other and below the ribs (at least 1 to 2 fingers), avoiding the circumference of the navel (1 to 2 fingers).
  • Site in the thigh: The upper part of the thigh, in front and on the outer side. From one hand below the groin to one hand above the knee, the hand being the child's.
  • Site in the buttock: the outer quarter of the top of the buttock and the flank, above the intergluteal groove.

EACH INJECTION SITE IS DIVIDED INTO ZONES

The belly is divided into 4 zones

Each thigh, arm or buttock is divided into 2 zones.

On the same site, use the same zone (1, 2, 3 or 4) for one week.
In each area, space the places of placement of the catheter by at least 2.5 cm, for example by turning clockwise. The following week, move on to another area.

Check before each injection that the chosen area is healthy: no oedema, scar, redness or infection.
The objective is to inject as little as possible in the same place and not to transplant at the same point before 6 to 8 weeks.
To facilitate this learning, use the rotation grids at the beginning, then if necessary.

ATMOSPHERE MATTERS:

To perform the injection in good conditions, it is important to prepare the equipment, to choose the place of the injection with the child, to find a comfortable position (to have supple skin and a relaxed muscle), to care in a serene and calm atmosphere.
A seated position is best for thigh and stomach injections. For injections in the arms and buttocks, it does not matter.
Rituals and distractions will help the small child, while confidence building and concentration will be necessary for the older child, if he is doing the injection.
The injection must be made immediately after having prepared the syringe in the case of rapid analog and NPH mixing to avoid changes in the action of the insulins.

The injection must be made into the subcutaneous tissue
Injection into the muscle (intramuscular) should be avoided, as there is a risk of hypoglycaemia (especially in the thigh).

In children:

  • it is preferable to systematically make a fold,
  • syringes with 6 mm needles will be preferred as soon as they are marketed because they guarantee subcutaneous injection where insulin resorption is predictable and regular.
The technique must be precise and identical from day to day.

HOW TO GIVE INSULIN INJECTION?

The injection is given immediately after preparing the pen or syringe.
We settle in a position that leaves the skin very supple in the injection area.
The injection is made on clean skin, it is disinfected if necessary.
We pinch the skin between the thumb and index finger to make a fold.
At the level of the arms, it is not possible to make the fold and to prick with one hand; so we have to get help.
Two techniques are possible. Generally, we place the syringe at the base of the fold, very obliquely, we prick by pushing the needle completely, we release the fold before injecting and we inject the insulin. In some cases, we can make the injection at the top of the fold, we then keep the fold until the end of the injection.

When the injection is finished, count slowly to 10, to avoid loss of insulin, and withdraw the needle straight, without turning the pen.

For the pen, the needle is unscrewed or cut with a needle cutter. It is thrown into a container reserved for this purpose. Put the pen cap back on.

For the syringe, cut the needle with a needle cutter or throw the syringe with its cap into a container reserved for this purpose.

WASTE TREATMENT (DASTRI)

The following information and images are taken from the website www.dastri.fr. The DASTRI is the eco-organization approved by the public authorities since December 2012 as part of an Extended Producer Responsibility (REP) sector concerning Waste from Healthcare Activities with Infectious Risks (DASRI).

Principle

The treatment of diabetes generates waste. Some are Sharp, Sharp, Sharp (PCT), others are soft waste. Only PCTs are supported bythe DASTRI sector. To be removed from the household waste circuit, they must be sorted by patients and stored in needle boxes.