Q: My patient gives injections through clothing and leaves insulin on the counter. What are the latest recommendations for using and storing insulin?
Safe use and storage of insulin are important topics that the home care nurse should periodically review with patients who use insulin. The recommended method for injecting insulin involves seven simple steps (American Association of Diabetes Educators [AADE], n.d.):
1. Choose a location that can be easily seen and reached, such as the abdomen (staying two fingers or a few inches away from the belly button), outer thighs, hips, buttocks, or backs of the arms. Remind the patient to rotate within, but not to overuse, one area. Rotation of the injection site is critical to prevent lipohypertrophy, a common consequence of inadequate site rotation.
2. Clean the area well (using alcohol to clean the area is generally not recommended).
3. Pinch up approximately 1 to 2 inches of skin and fat tissue.
4. Insert the needle into the fat layer at a 90-degree angle.
5. Let go of the pinched area and inject (keep the needle in place for 5 seconds after injecting if using a syringe or 10 seconds for a pen).
6. Pull the needle straight out and press on the area with your finger for 5 to 10 seconds to avoid insulin leakage (do not rub).
7. Dispose of the needle or syringe (do not recap syringes) in a thick plastic container with a screw-on lid. When the container is nearly full, screw the lid on tightly, secure with tape, then dispose of the container according to standards set forth by the local department of sanitation.
Although injecting insulin through clothing is not a recommended method, we know that some patients do inject through clothing because of convenience. There has been limited research around this practice. For example, a small study by Fleming, Jacober, Vandenberg, Fitzgerald, and Grunberger (1997) compared outcomes of adults who injected insulin through a single layer of clean clothing against those who injected directly into the skin. The researchers found that none of the subjects experienced erythema, induration, or abscess at injection sites and the A1c levels and leukocyte counts did not differ between the groups. However, practitioners are urged to exercise judgment before sanctioning this practice, taking into consideration the patient's personal hygiene and cleanliness of clothing (Siminerio et al., 2011).
Insulin should be stored according to the manufacturer's instructions, which means unused vials or pens should be refrigerated. However, vials or pens that are currently being used can be stored at room temperature (see package insert as time varies by product), but extreme temperatures (<36 to >86[degrees]F) including direct heat and sunlight should be avoided to prevent loss of potency. Patients should check the expiration date before opening the box of insulin, and visually examine the insulin bottle prior to each use to ensure there is no clumping, frosting, or alteration in the color or clarity of the insulin, which might indicate loss of potency (AADE, n.d.).
REFERENCES