Subcutaneous injection in the shoulder. Intradermal and subcutaneous injection: technique

The main advantage of an injection in the shoulder is that there is no need to remove the lower part of your clothing. In the context of a vaccination or treatment room, this is of paramount importance, as it allows vaccinations to be done much faster. Therefore, in Russian hospitals, shoulder injections are the most commonly practiced among children and adults. Often, subcutaneous or intradermal injections can be given at this site, however, in this article we will talk exclusively about intramuscular vaccinations. This procedure is correctly called “injection into the deltoid muscle of the shoulder.”

Place of vaccination

It would seem, why not do all intramuscular vaccinations in the shoulder, if it is so convenient? There are a number of reasons that may prevent you from injecting into this place:

Undeveloped muscles - if the patient suffers from dystrophy or is simply poorly developed physically, it can be quite difficult to get into the deltoid muscle. In this case, it is better to vaccinate in the gluteal muscle or thigh;
Inexperience of the person performing the procedure - a carelessly performed injection can lead to damage to the brachial or ulnar nerve or brachial artery. If the vaccinator is not confident in his accuracy, it is better to choose another place.
Injection performed independently - correctly injecting into the shoulder without assistance is much more difficult than in the thigh. If there is no assistant, it is better to avoid this method.
Extensive damage to the skin in the deltoid muscle area - this includes burns, birthmarks, large scars, and so on. For injection, it is better to choose the cleanest place on the skin.

If vaccination in the shoulder is possible, the first step is to decide on the injection site. An intramuscular injection is made strictly into the outer surface of the shoulder. It’s easy to find a suitable place for grafting: measure four fingers from the top of the shoulder joint and mark the center of the area. Another way: visually divide the arm from the elbow to the shoulder joint into three identical horizontal lines. The center of the middle region will also be the most suitable place for vaccination. The area is selected in such a way that anatomical differences between people or a small error will not result in hitting a nerve or artery. The injection site can also be seen in the image below.

Execution algorithm

Any medical procedure does not tolerate deviations from the instructions, including an injection in the shoulder. It is important to maintain sterility and sequence of vaccination. What you will need for the injection:

Three-component injection disposable syringe with a volume of up to 5 ml, needle length 50–70 mm, inner needle diameter 1–15 mm;
Drug solution, nail file for safe opening of ampoules;
Sterile cotton wool or special wipes for disinfection;
70% solution of medical alcohol;
Latex gloves;
Containers for disposal of medical instruments and consumables.

Make sure that medications are stored in accordance with the instructions. If storage conditions are not observed, the properties of the drug are lost within the first 3–4 hours.

How to properly inject into the deltoid muscle, step by step:

It is convenient to sit the patient down, explain the procedure to him and obtain consent for it.
Wash and dry your hands, put on sterile seals.
Place the needle on the syringe and turn it slightly clockwise to secure it.
Draw the required amount of the drug into the syringe, first checking the drug label and its expiration date.
Check for air in the syringe by spraying a small amount of solution out of it.
Treat the shoulder with a cotton swab or napkin moistened with alcohol, paying special attention to the injection site.
Stretch the skin at the injection site with the thumb and index finger of your free hand.
Securely take the syringe in your working hand, placing it between the middle and index fingers, fixing the piston with your thumb.
Smoothly insert the needle into the muscle, perpendicular to the surface of the skin by 2–3 cm.
Slowly increasing pressure with your finger on the syringe plunger, inject the drug into the deltoid muscle.
Smoothly remove the needle from the patient’s tissues along the same vector as during insertion.
Apply a new cotton swab or napkin moistened with alcohol to the vaccination site.
Throw away the used syringe and consumables, remove and discard gloves.

These instructions can be printed for convenience. At first, it is extremely difficult to remember all the nuances of this procedure without confusing anything.

Exactly following the instructions, which must always be followed, will ensure a high-quality injection, with virtually no pain.

Important Details

In addition to step-by-step instructions, you need to know the important features of the procedure in order to make injections easier and more painless. The very first thing to remember is the need to warm the drug to human body temperature or at least room temperature. The administration of cold medicine provides extremely unpleasant sensations and promotes aseptic inflammation (a sensitive swelling appears at the injection site), which takes up to 2 weeks. This rule includes the need to relax the muscles - tension only increases pain and makes it difficult for the needle to penetrate.

Large amounts of fatty tissue can also make it difficult for the needle to penetrate the muscle. If the person receiving the vaccine is obese, you may have to choose a longer needle. The recommended length in this case is equal to the thickness of the subcutaneous fat + 3 centimeters. The volume of adipose tissue can be approximately assessed by palpation (palpation). You can understand whether the needle has reached the muscle by a change in tissue resistance - the needle penetrates muscle tissue much harder than through the subcutaneous fat layer. If you cannot determine whether the needle is in the muscle tissue or not, you should inject again. Subcutaneous administration of solutions intended for intramuscular administration is strictly prohibited. Before injecting the drug solution into the muscle, pull the syringe back a few millimeters. This is necessary so that the medicine does not get into a blood vessel accidentally pierced by a needle.

The needle must be inserted confidently, with a gradual, uniformly accelerated movement. Under no circumstances should you inject with a “blow”. In this case, it is possible to pierce the entire muscle tissue down to the axillary tissue, which will bring severe pain to the patient. Also, do not inject an excessive amount of solution. If the doctor's prescription indicates large quantities of the drug intramuscularly, it is better to make several injections. Otherwise, aseptic inflammation of the muscle tissue with compression of the nerves will occur. This is extremely painful and can render the limb inoperative for some time.

This is all the important and necessary information for those who have to get intramuscular vaccinations in the shoulder. Try not to deviate from the instructions unless agreed upon by qualified physicians. We wish you easy, painless injections and more success in nursing!

Intradermal injection, nuances and execution algorithm Is fever after vaccination normal or a cause for concern?

With diabetes, patients have to inject insulin into the body every day to regulate blood sugar levels. For this purpose, it is important to be able to use insulin syringes yourself, calculate the dosage of the hormone and know the algorithm for administering a subcutaneous injection. Parents of children with diabetes should also be able to perform such manipulations.

The subcutaneous injection method is used most often in cases where it is required that the drug be absorbed into the blood evenly. The drug thus enters the subcutaneous fatty tissue.

This is a fairly painless procedure, so this method can be used for insulin therapy. If you use the intramuscular route to inject insulin into the body, absorption of the hormone occurs very quickly, so such an algorithm can harm a diabetic by causing glycemia.

It is important to consider that diabetes mellitus requires regular changes of subcutaneous injection sites. For this reason, after about a month, you should choose a different area of the body for the injection.

The technique of painlessly administering insulin is usually practiced on yourself, and the injection is given using a sterile saline solution. The algorithm for a competent injection can be explained by the attending physician.

The rules for performing a subcutaneous injection are quite simple. Before each procedure, you must wash your hands thoroughly with antibacterial soap; they can also be additionally treated with an antiseptic solution.

Insulin administration using syringes is performed using sterile rubber gloves. It is important to ensure proper lighting in the room.

To administer a subcutaneous injection you will need:

An insulin syringe with a needle of the required volume installed.
A sterile tray where cotton swabs and balls are placed.
Medical alcohol 70%, which is used to treat the skin at the site of the insulin injection.
Special container for the material used.
Disinfectant solution for processing syringes.

Before injecting insulin, a thorough inspection of the injection site should be performed. The skin should not show any damage, symptoms of dermatological disease or irritation. If there is swelling, a different area is selected for the injection.

For subcutaneous injection, you can use the following body parts:

Outer humeral surface;
Anterior outer surface of the thigh;
The lateral surface of the abdominal wall;
The area under the shoulder blade.

Since there is usually virtually no subcutaneous fat in the area of the arms and legs, insulin injections are not given there. Otherwise, the injection will not be subcutaneous, but intramuscular.

In addition to the fact that such a procedure is very painful, administering the hormone this way can lead to complications.

How is a subcutaneous injection done?

The diabetic makes an injection with one hand and holds the desired area of skin with the other. The algorithm for correct administration of the drug consists, first of all, in the correct capture of the skin fold.

With clean fingers, you need to grab the area of the skin where the injection will be administered into the fold.

There is no need to squeeze the skin, as this will lead to bruising.

It is important to choose a suitable area where there is a lot of subcutaneous tissue. If you are thin, this place can be the gluteal region. To carry out the injection, you don’t even need to make a fold, you just need to feel the fat under the skin and inject into it.
The insulin syringe should be held like a dart - using your thumb and three other fingers. The technique of administering insulin has a basic rule - so that the injection does not cause pain to the patient, it must be done quickly.
The algorithm for performing a shot is similar in action to throwing a dart; the darts playing technique will be an ideal hint. The main thing is to hold the syringe tightly so that it does not jump out of your hands. If the doctor taught you to administer a subcutaneous injection by touching the tip of the needle to the skin and gradually pressing in, this method is erroneous.
The skin fold is formed depending on the length of the needle. For obvious reasons, insulin syringes with short needles will be most convenient and will not cause pain to a diabetic.
The syringe accelerates to the required speed when it is at a distance of ten centimeters from the site of the future injection. This will allow the needle to instantly penetrate the skin. Acceleration is imparted through the movement of the entire arm, the forearm also participates in this. When the syringe is close to the skin area, the wrist guides the tip of the needle exactly to the target.
After the needle penetrates the skin, you need to press the piston all the way, injecting the entire volume of insulin. After the injection, you cannot immediately remove the needle; you need to wait five seconds, after which it is removed with quick movements.

You should not use oranges or other fruits as a workout.

To learn how to accurately hit the desired target, the throwing technique is practiced with a syringe with a plastic cap on the needle.

How to fill a syringe

It is important not only to know the algorithm for performing injections, but also to be able to correctly fill the syringe and know.

After removing the plastic cap, you need to draw a certain amount of air into the syringe, equal to the volume of insulin injected.
Using a syringe, the rubber cap on the bottle is pierced, after which all the collected air is released from the syringe.
After this, the syringe with the bottle is turned upside down and held vertically.
The syringe must be pressed tightly into the palm of your hand using your little fingers, after which the piston is sharply pulled down.
You need to draw into the syringe a dosage of insulin that is 10 units more than required.
The piston is pressed smoothly until the required dose of the drug is in the syringe.
After removal from the bottle, the syringe is held vertically.

Simultaneous administration of different types of insulin

Diabetics often use different types of insulin in order to urgently normalize blood sugar levels. Usually this injection is carried out in the morning.

The algorithm has a certain sequence of injections:

Initially, you need to inject ultra-thin insulin.
Next, short-acting insulin is administered.
After this, extended-release insulin is used.

If Lantus is used as a long-acting hormone, the injection is performed using a separate syringe. The fact is that if any dose of another hormone gets into the bottle, the acidity of insulin changes, which can lead to unpredictable consequences.

Under no circumstances should you mix different types of hormones in a common bottle or in one syringe. An exception would be Hagedorn neutral protamine insulin, which slows down the action of short-acting insulin before meals.

If insulin leaks at the injection site

After the injection is completed, you need to touch the injection site and raise your finger to your nose. If you smell preservatives, this indicates that insulin has leaked from the puncture area.

In this case, you should not additionally administer the missing dose of the hormone. It should be noted in the diary that there was a loss of the drug. If a diabetic's sugar increases, the reason for this condition will be obvious and clear. It is necessary to normalize blood glucose levels when the effect of the administered hormone is completed.

If you need to inject yourself, it is important to know how to do it easily and painlessly. After all, doctors often prescribe a complex of drugs for treatment, including injections.
And problems do not arise if one of the relatives has a similar skill.

Orthopedist-traumatologist: Azalia Solntseva ✓ Article checked by doctor

Injections under the skin

Injecting the medicine subcutaneously involves placing an injection into the fatty layer located directly under the skin.

First of all, determine the injection site.

Most often, a subcutaneous injection is performed in the following places:

in the hand between the elbow and shoulder from behind or from the side;
in the anterior abdominal region above the hip and below the ribs, excluding the navel area;
into the area of the leg between the knee, thigh and groin.

The process of giving a subcutaneous injection to yourself includes the following steps:

wash your hands methodically with soap;
wipe the selected area with an alcohol-soaked cotton swab;
take a syringe with the drug prepared in advance, remove the cap;
carefully gather 2.5-5 cm of skin into a fold to increase the thickness of subcutaneous fat and more accurately deliver the substance into the fat layer and not into the muscle;
With a quick movement, insert the needle at an angle of 90 degrees into the entire length of the fold and release the skin;
at the same speed, pressing the piston, inject the drug;
Apply an alcohol-soaked cotton pad, remove the needle and hold the cotton pad for a while.

Identification procedure

Before administering the medicine, you will need to select a site.

To do this, you need to imagine a cross on the buttock, dividing it into 4 parts.

The injection should be carried out in the upper outer quadrant; here the risk of injury to the sciatic nerve is low.

After determining the site, you need to follow simple rules for placing an injection:

wash your hands with soap;
take a comfortable position standing or lying down;
bend your leg to relax the muscle;
wipe the injection area with an alcohol-soaked cotton pad;
remove the cap from the syringe;
insert the needle perpendicularly into the injection area 2/3 of its length;
inject the drug by gently pressing on the piston;
quickly remove the needle;
Press a cotton swab treated with an alcohol solution onto the area.

To avoid lumps, bruises and ensure better absorption of the medicine, you can gently massage and knead the injection site with your fingers.

Injection

The procedure is not complicated. The main thing is to overcome uncertainty and follow some rules for giving injections yourself.

Immediately before the process, you should prepare everything you need.

For the procedure you will need:

disposable syringe with a volume of 2.5–11 ml, depending on the amount of the drug administered. When choosing a syringe, you should be guided by the injection site. If the substance is administered intramuscularly, you should choose syringes with the longest needles. When injecting subcutaneously, for example into the arm, the needle should be short;
ampoule with medicine;
alcohol to disinfect the injection area;
cotton balls, disks or napkins.

After methodically washing your hands, you need to take the ampoule, treat it with an alcohol solution, shake the contents and file the tip with a special nail file. You should file at a distance of approximately 1 cm from the beginning of the ampoule.
Then wrap the tip with a cotton pad and carefully break it off.
Next, remove the cap from the syringe needle and immerse it to the bottom in the ampoule.
Draw up the medicine and, holding the syringe in a vertical position, tap it with your fingertip. This is necessary so that the air remaining in the container collects in its upper part.
Next, gradually pressing on the piston, you should push the air bubble out of the syringe through the needle and wait until a drop of the drug appears at its tip.
Close the prepared syringe with a cap, set it aside and select places to inject the product.

Medical experts advise giving injections intramuscularly in the buttock. Inject into the arm or thigh, but in the first case, a lack of muscle mass is likely, and in the second, an unpleasant pulling sensation in the leg after the injection.

The part of the body where the injection site is located should be in a relaxed state.

The position when giving the injection should first of all be comfortable. It is recommended to carry out the procedure while standing half-sided towards the mirror, but it is also possible to administer the drug while lying on your side. The main thing is that the surface is hard enough.

Video

Safety regulations

How to give an intramuscular injection, following the necessary safety rules:

The injection site should not have any damage, wounds, or purulent inflammation. If any, it is necessary to determine another injection site.
Mandatory alternation of injection areas to avoid damage to the skin.
Do not reuse a needle or syringe. At the end of the procedure, used instruments should be disposed of.

The most common problem after an intramuscular injection is a hematoma or bruise.

It can occur when small vessels are damaged by a needle or the drug is administered too quickly.

The bruise goes away on its own and does not require additional treatment.

If the medicine injected into the muscle is not completely absorbed, a compaction may form under the skin. Here it is possible to use pharmaceutical ointments to speed up resorption or apply warm compresses.

The most unpleasant complication may be the appearance of an abscess.

It is an abscess that forms when harmful microbes enter the skin at the time of injection. This happens in case of insufficient disinfection of the injection area, hands and non-compliance with general safety rules.

Signs of this phenomenon are:

compaction;
redness;
throbbing pain.

In such a situation, you should consult a doctor. In this case, you should not touch the sore spot with your hands for the purpose of massage or applying compresses. Therapeutic actions are carried out only as prescribed by a doctor. If the problem is advanced, surgical intervention may be required.

Carrying out the procedure for giving injections to yourself generally does not pose any significant difficulties. The main thing is to follow the rules of disinfection, hygiene and the right choice of injection site. But if you have the slightest uncertainty, consult a specialist for the procedure to avoid possible complications.

Procedure for a child

Also, some parents are faced with the question of how to give an intramuscular injection to their child’s buttock.

Almost all children are terrified of any injections and are sensitive to pain, so special preparation is required here.

For intramuscular injections, the baby needs to choose a syringe with the thinnest needle, and before the procedure itself, you can do a light massage of the soft spot. This way the child will feel virtually no pain and will stop feeling fear.

It is best to place the baby on his stomach. It is desirable that the surface is hard. If there is no such place in the house, then you can place it on your lap.

If the child resists, it is better to ask one adult to hold him. If the baby has been restrained, it is necessary to carefully and confidently insert the syringe in the same way as an adult.

You can’t feel sorry for the baby and be distracted by screams. By feeling sorry for the child, you can break the technology, which will lead to unpleasant sensations.

There are several tips on how to give an intramuscular injection in the buttock without outside help. They will help you learn quickly and make the process as painless as possible:

For the procedure, it is advisable to choose modern syringes with a rubber tip on the piston.
The syringe is intended for single use only.
If a course of injections has been prescribed, you should not inject in the same place.
It is advisable to warm up ampoules with oil solutions first in your hands or under running warm water.
After the needle is inserted into the muscle, you need to slightly pull the piston up. If blood enters it, it means that the vessel has been touched. The fix is simple. You just need to deepen the puncture a little.

How to easily inject yourself

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Subcutaneous injections are a highly sought after medical procedure. The technique for performing it differs from the technique for administering drugs intramuscularly, although the preparation algorithm is similar.

The injection should be made subcutaneously less deeply: it is enough to insert the needle inside just 15 mm. Subcutaneous tissue has a good blood supply, which determines the high rate of absorption and, accordingly, the action of the drugs. Just 30 minutes after administration of the medicinal solution, the maximum effect of its action is observed.

The most convenient places for administering drugs subcutaneously:

shoulder (its outer region or middle third);
anterior outer surface of the thighs;
lateral part of the abdominal wall;
subscapular region in the presence of pronounced subcutaneous fat.

Preparatory stage

The algorithm for performing any medical procedure, as a result of which the integrity of the patient’s tissues is violated, begins with preparation. Before giving the injection, you should disinfect your hands: wash them with antibacterial soap or treat them with an antiseptic.

Important: In order to protect their own health, the standard algorithm for the work of medical personnel during any type of contact with patients involves wearing sterile gloves.

Preparation of instruments and preparations:

a sterile tray (a clean ceramic plate that has been disinfected by wiping) and a tray for waste materials;
a syringe with a volume of 1 or 2 ml with a needle with a length of 2 to 3 cm and a diameter of no more than 0.5 mm;
sterile wipes (cotton swabs) – 4 pcs.;
prescribed drug;
alcohol 70%.

Everything that will be used during the procedure should be on a sterile tray. You should check the expiration date and tightness of the packaging of the medicine and the syringe.

The place where you plan to give the injection must be inspected for the presence of:

mechanical damage;
swelling;
signs of dermatological diseases;
manifestation of allergies.

If the selected area has the problems described above, the location of the intervention should be changed.

Taking medicine

The algorithm for withdrawing the prescribed drug into a syringe is standard:

checking the compliance of the medicine contained in the ampoule with that prescribed by the doctor;
clarification of dosage;
disinfection of the neck at the point of its transition from the wide part to the narrow part and incision with a special file supplied in the same box with the medicine. Sometimes ampoules have specially weakened places for opening, made in a factory way. Then there will be a mark on the vessel in the indicated area - a colored horizontal stripe. The removed top of the ampoule is placed in a waste tray;
the ampoule is opened by wrapping the neck with a sterile swab and breaking it away from you;
the syringe is opened, its cannula is combined with the needle, and then the case is removed from it;
the needle is placed in the opened ampoule;
the syringe plunger is pulled back with the thumb, and liquid is drawn out;
the syringe rises with the needle up; the cylinder should be lightly tapped with your finger to displace the air. Push the medicine with the plunger until a drop appears at the tip of the needle;
attach the needle case.

Before making subcutaneous injections, it is necessary to disinfect the surgical field (side, shoulder): with one (large) swab soaked in alcohol, a large surface is treated, with a second (middle) one, the place where the injection is directly planned to be placed. Technique for sterilizing the work area: moving the swab centrifugally or from top to bottom. The injection site should be dry from alcohol.

Manipulation algorithm:

the syringe is taken in the right hand. The index finger is placed on the cannula, the little finger is placed on the piston, the rest will be on the cylinder;
With your left hand – thumb and index finger – grab the skin. There should be a skin fold;
to make an injection, the needle is inserted with a cut upward at an angle of 40-45º for 2/3 of the length into the base of the resulting skin fold;
the index finger of the right hand maintains its position on the cannula, and the left hand moves to the piston and begins to press it, slowly injecting the medicine;
a swab soaked in alcohol is easily pressed against the insertion site of the needle, which can now be removed. Safety precautions stipulate that during the process of removing the tip, you should hold the place where the needle is attached to the syringe;
after finishing the injection, the patient should hold the cotton ball for another 5 minutes, the used syringe is separated from the needle. The syringe is thrown away, the cannula and needle break.

Important: Before giving the injection, the patient must be positioned comfortably. During the injection process, it is necessary to continuously monitor the person’s condition and his reaction to the intervention. Sometimes it is better to give the injection while the patient is lying down.

When you finish giving the injection, remove the gloves if you were wearing them and disinfect your hands again: wash or wipe with an antiseptic.

If you completely follow the algorithm for performing this manipulation, then the risk of infections, infiltrates and other negative consequences is sharply reduced.

Oil solutions

It is prohibited to make intravenous injections with oil solutions: such substances clog blood vessels, disrupting the nutrition of adjacent tissues, causing their necrosis. Oil emboli may well end up in the vessels of the lungs, blocking them, which will lead to severe suffocation, followed by death.

Oily preparations are poorly absorbed, so infiltrates are common at the injection site.

Tip: To prevent infiltration, you can put a heating pad (make a warm compress) at the injection site.

The algorithm for introducing the oil solution involves preheating the drug to 38ºC. Before injecting and administering the medicine, you should insert the needle under the patient's skin, pull the plunger of the syringe towards you and make sure that no blood vessel has been damaged. If blood enters the cylinder, lightly press the needle insertion site with a sterile swab, remove the needle and try again in another place. In this case, safety precautions require replacing the needle, because used is no longer sterile.

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SELECTION OF DRUG ADMINISTRATION SITE

Except in special situations, insulin is injected only into the subcutaneous fat. Intramuscular and intradermal injections should be avoided. Subcutaneous fat is limited by the skin (epidermis and dermis) on one side, fascia and muscle on the other.

Structure of skin and subcutaneous fat

For drug injections, subcutaneous fat tissue of the following areas of the body is used:

Subcutaneous injection sites

Anterior abdominal wall. Place your palms on either side of your navel. These areas are used to administer the drug. Moving externally along the surface of the anterior abdominal wall is not recommended in thin patients, since the thickness of the subcutaneous fat decreases, which increases the risk of intramuscular injection. Also, you should not inject into the navel and midline of the abdomen, where the subcutaneous fat is thin. The injection area is limited from above by the xiphoid process of the sternum, from below – by the pubic area. The rate of absorption from the subcutaneous fat of this anatomical region is high.

Injections into the anterior abdominal wall

Anterior outer surface of the thighs. Feel the two large protrusions on the side of the upper thighs - the greater trochanters of the femurs. Place your palms so that their bases are located immediately under these protrusions. In this case, the area of the palms limits the areas of the thigh where injections can be performed. The rate of absorption from the subcutaneous fat of the thighs is low.

Injections into the thigh area

Upper outer square of the buttocks. The upper outer square of the buttocks limits the area for insulin injections. The rate of absorption from the subcutaneous fat in this area is low.

Injections into the buttocks area

Outer surface of the shoulder. Typically, the shoulder area is not recommended for self-injections due to the high risk of intramuscular injection of the drug (it is impossible to form a skin fold). If injections are performed by another person, they should be performed on the outer surface of the shoulder. The rate of absorption of drugs from the subcutaneous fat of this area is relatively high.

Shoulder injections

INSULIN ANALOGUES AND AGONISTS OF GLUCAGON-LIKE PEPTIDE-1 RECEPTORS

To administer fast-acting and mixed insulin analogues, you can use skin areas of any localization, since they are absorbed everywhere at the same speed
Rapid-acting insulin analogues should not be administered intramuscularly, although studies have shown that adipose tissue and relaxed muscle have similar rates of absorption. However, the rate of absorption from the contracting muscle has not been studied.
Long-acting insulin analogues can be injected into any standard injection site because they are absorbed at the same rate everywhere.
The possibility of intramuscular injections of long-acting insulin analogues and mixed analogues should be excluded due to the risk of developing severe hypoglycemia. Patients who exercise after receiving long-acting insulin analog injections should be aware of the possible risk of hypoglycemia.
In some cases, it may be preferable to split relatively large doses of insulin into two injections, given one after the other in different locations. There is no universal threshold value for dividing doses, but, as a rule, a value of 40-50 units is taken as it.

HUMAN INSULINS

Soluble, short-acting human insulins may have a slower rate of absorption than their rapid-acting counterparts. Older long-acting drugs (eg, NPH insulin) have pharmacological peaks that can cause hypoglycemia, especially when administered in relatively large doses. When using human insulin, it may be advisable to split large doses of insulin into two injections. There is no universal threshold value for dividing doses, but, as a rule, a value of 40-5o units is taken as it.

It is necessary to avoid intramuscular injections of short-acting insulin and NPH insulin due to the risk of developing severe hypoglycemia.
The thighs and buttocks are preferred when using NPH insulin as basal insulin as absorption from these sites is slowest. Whenever possible, NPH insulin should be administered at bedtime rather than before dinner to reduce the risk of nocturnal hypoglycemia.
Soluble short-acting human insulins are absorbed most quickly when injected into the abdominal area, so they are preferably injected into this area.
Absorption of short-acting soluble human insulins may be slower in older adults, so these insulins should not be used when rapid action is needed.
Given the differences in the rate of absorption of human insulins from different areas, the pattern of alternating injection sites should be the same every day.

Mixed human insulins containing NPH insulin are recommended to be administered into the abdominal area in the morning. This is useful to speed up the absorption of short-acting insulin to control fluctuations in blood glucose levels after breakfast.
In the evening, mixed insulin should be injected into the thigh or buttocks, as this results in slower absorption and reduces the risk of nocturnal hypoglycemia.

SELECTION OF NEEDLE LENGTH

The main goal of injecting insulin is to reliably deliver the active substance into the subcutaneous space without leaking back out, as well as with minimal pain and discomfort. The main condition for achieving this goal is the choice of a needle of optimal length. The choice of needle length is an individualized, joint decision between the patient and his or her physician, taking into account multiple factors, including physical, pharmacological, and psychological. There are needles with lengths of 4, 5, 6, 8, 10, 12, 12.7 mm. Shorter needles are safer and generally less painful.

4 mm 5 mm 8 mm 12.7 mm

Needles for syringe pens of different lengths

CHOOSING NEEDLE LENGTH IN ADULTS

The thickness of subcutaneous fat in adults varies depending on gender and body area, while the thickness of the skin (epidermis and dermis) differs minimally.

Needles of 4 and 5 mm can be used by all adult patients, including obese people, and generally do not require skin fold formation.
In adult patients, injections using short needles (4 and 5 mm) should be performed at an angle of 90° to the skin surface.
Creating a skin fold and/or injecting at a 45° angle may be necessary when injecting with short needles (4 and 5 mm) on the extremities or slender abdomen.
There is no medical reason to recommend the use of needles longer than 8 mm. Therapy should begin with shorter needles.
Patients already using needles 8 mm or longer in length should form a fold or inject at a 45° angle to avoid intramuscular injection.

CHOOSING NEEDLE LENGTH IN PREGNANT WOMEN

To clarify the issue of the peculiarities of injections for pregnant women, additional research needs to be conducted. The use of fetal ultrasound allows healthcare providers to assess the thickness of subcutaneous fat and make a list of recommendations for injection techniques. In the absence of such studies, the following recommendations seem reasonable:

A pregnant woman with any type of diabetes who continues to have injections in the abdominal area should form a skin fold with each injection.
During the last trimester of pregnancy, injections should not be performed in the periumbilical area.
During this period, you can continue to perform injections into the lateral sides of the abdomen, provided that a skin fold is formed.

PERFORMING AN INJECTION INTO A SKIN FOLD

In cases where the distance between the surface of the skin and the muscle is less than the length of the needle used, the formation and lifting of a skin fold is a prerequisite. Gathering a skin fold on the abdomen is relatively easy (except for very thick, tight bellies). It is much more difficult to do this in the area of the hips and buttocks (in the latter case this is rarely necessary). It is almost impossible (for patients performing injections on their own) to correctly perform this manipulation on the shoulders. The correct skin fold is collected using the thumb and index finger (with the possible addition of the middle finger). Forming a skin fold using the entire arm carries the risk of trapping the muscle along with the subcutaneous tissue and may lead to intramuscular injection. Do not release the fold until the end of the injection. Do not squeeze the skin too hard, that is, until it becomes pale or painful.

INJECTIONS AT AN ANGLE TO THE SKIN SURFACE

You can further reduce the risk of intramuscular injection by using the method of inserting the needle at an angle to the surface of the skin. When combined with a skin fold, this technique can reduce the risk of intramuscular injections, especially when using long needles.

INJECTION METHOD

Typically, subcutaneous injections are painless unless the needle goes directly into a nerve ending.

Injection sequence

Set the number of units of insulin that you plan to inject on the pen scale. If you are using an insulin syringe, draw the required dose of insulin.
Clear some space on your skin from clothing.
Move 1-2 cm away from the previous injection site.
Remove the protective cap from the needle.
If necessary, create a skin fold.
Insert the needle into the subcutaneous fat (at an angle of 90 o or 45 o).
Pierce the skin with a quick movement.
Smoothly press the injection button of the syringe pen or the plunger of the syringe. Inject the solution slowly and make sure that the syringe plunger or pen button is fully pressed.
Hold the needle in the subcutaneous fat for at least 10 seconds, continuing to press the button or piston so that the entire dose reaches the destination and the drug does not leak out. When administering higher doses, it may be necessary to increase the needle retention time.
Remove the needle at the same angle at which it was inserted.
Straighten the skin fold.
Sometimes a small drop of blood may appear at the injection site, in this case, press the injection site with your finger for a while.
When using a pen, carefully place the outer cap on the needle, twist it, and discard it. Syringes must also be disposed of.
It is not recommended to massage or rub the injection site. Massaging before injection may speed up absorption, but is generally not recommended.

Injection with a pen

The following tips will help make injections less painful:

Store the insulin you use at room temperature.
If you use alcohol on your skin, inject only after it has evaporated.
Do not inject into the hair roots.
Use needles with a smaller length and diameter.

ALTERNATING INJECTION SITES

Numerous studies have shown that in order to reduce trauma, it is necessary to correctly alternate injection sites.

It is necessary from the very beginning to get accustomed to an easy-to-memorize pattern of alternating injection areas.
One proven regimen divides the injection area into four quadrants (or halves in the case of the thighs and buttocks), using only one quadrant each week and then rotating the next one in a clockwise direction.
According to another scheme, it is possible to evenly alternate injection sites within the entire anatomical region.
Injections within any area should be spaced at least 1 cm apart to avoid re-injury to tissue.

Scheme of alternating injection sites divided into quadrants

Scheme of uniform alternation of injection sites