gestational diabetes: giving yourself insulin shots

overview

if you have gestational diabetes, and if treatments such as healthy eating, exercise, and medicines aren't enough to keep your blood sugar levels within a target range, then you may need insulin shots. taking insulin can help prevent high blood sugar. high blood sugar can lead to problems for you and your baby.

you may be nervous giving a shot at first. but soon, giving yourself a shot will become routine. your care team will show you how to draw up insulin into a syringe and give the shot. the needles you use to give the insulin injections are very thin. most people who use insulin say they don't even feel the needle enter the skin. if you do feel the injection, the sting of the shot doesn't last long.

how to prepare and give an insulin shot

getting started

• gather your supplies. you will need an insulin syringe, your bottle of insulin, and an alcohol wipe or a cotton ball dipped in alcohol. keep your supplies in a bag or kit so you can carry the supplies wherever you go.
• check the insulin bottle label and contents. read and follow all instructions on the label, including how to store the insulin and how long the insulin will last.
• wash your hands with soap and running water. dry them well.

preparing the shot

sometimes you may use a single type of insulin. this is called a single-dose insulin shot. and sometimes you may mix two types of insulin in the syringe. this is called a mixed-dose insulin shot. your doctor will tell you whether and when to use each type of shot.

to prepare a single-dose insulin shot:

1. roll the bottle gently between your hands. this will warm the insulin if you have kept the bottle in the refrigerator. roll a bottle of cloudy insulin between your hands until the white powder has dissolved and the solution is mixed.
2. wipe the rubber lid of the insulin bottle with an alcohol wipe or a cotton ball dipped in alcohol. (if you are using a bottle for the first time, remove the protective cover over the rubber lid.) let the top dry before you remove any insulin.
3. remove the plastic cap from the needle on your insulin syringe. take care not to touch the needle.
4. pull back the plunger of the syringe, and draw air into the syringe equal to the number of units of insulin to be given.
5. insert the needle of the syringe into the rubber lid of the insulin bottle. push the plunger of the syringe to force the air into the bottle. this equalizes the pressure in the bottle when you remove the dose of insulin. leave the needle in the bottle.
6. turn the bottle and syringe upside down, and hold them in one hand. position the tip of the needle so that it is below the surface of insulin in the bottle. pull back the plunger to fill the syringe with slightly more than the correct number of units of insulin to be given.
7. tap the outside (barrel) of the syringe so that trapped air bubbles move into the needle area. push the air bubbles back into the bottle. make sure you now have the correct number of units of insulin in your syringe.
8. remove the needle from the bottle. now you are ready to give the shot.

to prepare a mixed-dose insulin shot:

1. roll the cloudy insulin bottle (vial) gently between your hands. roll the cloudy insulin bottle until all the white powder has dissolved. rolling the bottle warms the insulin if you have been keeping the bottle in the refrigerator. do not shake an insulin bottle.
2. clean the lids of the bottles. if you are using a bottle for the first time, remove the protective cover from the rubber lid. if the rubber lid of the insulin bottle is dirty, clean it with an alcohol wipe or a cotton ball dipped in alcohol. let the alcohol dry.
3. draw air into the syringe for the cloudy insulin dose.
   1. remove the plastic cap that covers the needle on your insulin syringe. important: do not touch the needle.
   2. pull back the plunger on your insulin syringe, and draw air into the syringe equal to the number of units of cloudy insulin to be given.
4. force air into the cloudy insulin bottle.
   1. push the needle of the syringe into the rubber lid of the cloudy insulin bottle.
   2. push the plunger of the syringe to force the air into the bottle. this equalizes the pressure in the bottle when you later remove the dose of insulin.
   3. remove the needle from the bottle.
5. draw air into the syringe for the clear insulin dose. pull back the plunger of the syringe, and draw air into the syringe equal to the number of units of clear insulin to be given.
6. force air into the clear insulin bottle.
   1. push the needle of the syringe into the rubber lid of the clear insulin bottle. note: you will draw the clear insulin into the syringe first, then the cloudy insulin (step 8). it is important to follow this order.
   2. push the plunger to force the air into the bottle. leave the needle in place.
7. draw clear insulin into the syringe.
   1. turn the bottle and syringe upside down. position the tip of the needle so that it is below the surface of insulin in the bottle.
   2. pull back the plunger to fill the syringe with slightly more than the correct number of units of clear insulin to be given.
   3. tap the barrel of the syringe so that trapped air bubbles move into the needle area. push the air bubbles back into the bottle. important: make sure that you have the correct number of units of insulin in your syringe.
   4. remove the needle from the clear insulin bottle.
8. insert the needle into the cloudy insulin bottle. insert the needle into the rubber lid of the cloudy insulin bottle. important: do not push the plunger because this would force clear insulin into your cloudy insulin bottle. if clear insulin is mixed in the bottle of cloudy, it will alter the action of your other doses from that bottle.
9. draw cloudy insulin into the syringe.
   1. turn the bottle and syringe upside down. position the tip of the needle so that it is below the surface of insulin in the bottle.
   2. slowly pull back the plunger of the syringe to fill the syringe with the correct number of units of cloudy insulin to be given. this will prevent air bubbles entering the syringe.
   3. remove the needle from the bottle. you should now have the total number of units for the clear and cloudy insulin in your syringe. for example, if you need 10 units of clear and 15 units of cloudy, you should have 25 units in your syringe. now you are ready to give the shot.

giving the shot

1. make sure the area of skin where you will give the shot is clean. if you use alcohol to clean the skin, let it dry.
2. slightly pinch a fold of skin between your fingers and thumb of one hand.
3. hold the syringe like a pencil close to the site, keeping your fingers off the plunger. it is usually recommended to place the syringe at a 90-degree angle to the shot site, standing straight up from the skin.
4. bend your wrist, and quickly push the needle all the way into the pinched-up area.
5. push the plunger of the syringe all the way in so the insulin goes into the fatty tissue.
6. take the needle out at the same angle that you inserted it. if you bleed a little, apply pressure over the shot area with your finger, a cotton ball, or a piece of gauze. do not rub the area.
7. replace the cover over the needle and dispose of the needle safely. do not use the same needle more than one time.

where to give the shot

you can inject insulin at a few places on the body. these places include:

• the belly, but at least 5 centimetres (2 inches) from the belly button. this is considered the best place to inject insulin. if you are in your third trimester, your skin over your belly may be too tight. find a spot on the side of your belly where you can raise your skin in a fold between your fingers.
• the top outer part of the thighs. insulin usually is absorbed more slowly from this site, unless you exercise soon after giving the shot.
• the outside of the upper arms. you may need help giving yourself shots in this area.
• the buttocks. you may need help with injections in the buttocks.

your doctor may advise you to give your shots in different places on your body each day. this is called site rotation. if you are going to rotate sites, check with your doctor to make sure you know how to do it right. use the same site at the same time of each day. for example, each day:

• at breakfast, give the shot in one of your arms.
• at lunch, give the shot in one of your legs.
• at dinner, give the shot in your belly.

slightly change the spot where you give an insulin shot each time you do it. for example, use five different places on the right upper arm, then use five places on the left upper arm. using the same spot every time can cause bumps or pits in the skin and make the shots hurt more. it may also slow down how the insulin is absorbed into your body.