Diabetes Hub: Guide to Managing Diabetes

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Treatment

How medications work

Medications work in different ways, on different body parts

A

Liver, fat tissues and muscles
E.g. Pioglitazone, metformin

Reduces amount of sugar made by the liver, and increases the sensitivity of fat, liver and muscle cells to insulin

B

Liver and pancreas
E.g. Linagliptin, sitagliptin

Helps the pancreas produce more insulin and reduce amount of sugar made by the liver

C

Kidneys
E.g. Dapagliflozin, empagliflozin

Prevents the kidneys from re-absorbing sugar

D

Intestines
E.g. Acarbose

Slows down breakdown of starch and absorption of sugar from the intestines

E

Pancreas
E.g. Glipizide, tolbutamide, gliclazide

Helps the pancreas produce more insulin

Taking medications

Take your prescribed medications to help manage diabetes

Take your medication as prescribed

Take your medication(s) regularly at the correct time(s)

If you miss a dose, take it as soon as you remember to help manage diabetes

If you miss a dose, take it as soon as you remember; if it is time for the next dose, skip the missed dose

Eat meals regularly to prevent hypoglycaemia and manage diabetes

Eat meals regularly to prevent hypoglycaemia (low blood sugar)

Avoid taking alcohol if you're on medication

Avoid taking alcohol with medication

Inform your healthcare professional if you are:

Taking metformin before going for any scans (e.g. X-ray) or procedures

Pregnant or planning to get pregnant before taking medication

Experiencing persistent symptoms of hypoglycaemia (low blood sugar)

Types of tablets and their uses & side effects

Insulin therapy

Insulin injections improve blood sugar control and prevent complications

Insulin injections can help

Improve blood sugar control
Prevent or delay complications

Insulin injections may cause

Hypoglycaemia (low blood sugar)
Potential weight gain

Insulin allows sugar (glucose) into the body cell

Insulin allows sugar into your body cell

How different types of insulin affect your blood sugar level throughout the day

Frequent intake of sugar and refined carbohydrates causes your pancreas to work harder

Legend

Mealtime insulin
Basal insulin (long-acting or intermediate acting)

How to inject insulin

Insulin Injection胰岛素疗程 Terapi Insulin இன்சுலின் சிகிச்சை

Part 1: How to draw insulin from a vial

Gather your supplies

1. Vial

Gather your supplies like syringe and plunger before drawing insulin from a vial

2. Syringe and plunger

Gather your supplies like an alcohol swab before drawing insulin from a vial

3. Swab

Preparation

Follow these steps to prepare your single or mixed insulin

Gather your supplies in preparing your single or mixed insulin

1. Gather your supplies
(syringe, insulin, alcohol swabs)

Wash your hands with soap and running water then dry it when preparing your single or mixed insulin

2. Wash your hands with soap and running water then dry your hands thoroughly

To prepare an insulin injection, roll the vial between the palms of your hands to mix it

3. Roll the vial insulin (if the insulin is cloudy)
between the palms of your hands to mix it and/or warm it up to body temperature

To prepare a single or mixed insulin, clean the rubber stopper on the vial with an alcohol swab

4. Clean the rubber stopper on the vial with an alcohol swab

Part 2: How to draw a dose (single)

If you are drawing a SINGLE dose

After completing part 1 (preparation), follow these steps to draw a SINGLE dose of insulin into the syringe

Draw air into the syringe to the level prescribed for your single insulin dose

1. Draw air into the syringe to the level prescribed for your insulin dose

For injecting a single dose of insulin, inject the air does into the vial with it standing upright

2. With the vial standing upright, inject the air dose into the vial by pushing down the plunger

Turn the vial and syringe upside down if you're drawing a single dose

3. Turn the vial and syringe upside down, ensure the needle tip is covered by the liquid

Pull back the plunger to withdraw insulin if you are drawing a single dose

4. Pull back the plunger to withdraw insulin to the level of the prescribed dose

Gently flick the side of the syringe if you are drawing a single dose of insulin

5. Gently flick the side of the syringe to remove air bubbles, if needed

Part 2: How to draw a dose (mixed)

If you are drawing a MIXED (clear + cloudy insulin) dose

After completing part 1 (preparation), follow these steps to draw a MIXED dose of insulin into the syringe

1. Draw air into the syringe to the level prescribed for your cloudy insulin dose

To draw a dose of mixed insulin, insert the syringe into the cloudy vial and push down the plunger

2. Insert the syringe into the cloudy vial and inject the air dose into the vial by pushing down the plunger - remove the syringe without drawing the insulin

3. Draw air into the syringe to the level prescribed for your clear insulin dose

Draw air into the syringe to the level prescribed if you are drawing a mixed dose of insulin

4. Inject the air dose into the clear vial in an upright position

Turn the vial and syringe upside to ensure the needle tip is covered with liquid

5. Turn the vial and syringe upside down ensure the needle tip is covered by the liquid

6. Slowly pull back the plunger to withdraw clear insulin to the level prescribed

To draw a mixed dose, removed the partially filled syringe and insert the vial of cloudy insulin

7. Removed the partly filled syringe from the clear vial and insert it in the vial of cloudy insulin

8. Turn the vial and syringe upside down, and slowly withdraw to the level prescribed for total amount of insulin (clear + cloudy)

Part 3: How to inject insulin

Step-by-step guide to injecting insulin into your chosen site

Clean your chosen site with water and tissue before injecting insulin

1. Clean your chosen site with water and tissue

To inject insulin, lift the skin with your thumb and finger on the chosen site

2. Lift the skin with your thumb and finger on the chosen site. With your other hand, hold the syringe (like a pencil, keeping fingers off the plunger) close to the chosen site at a 90 degree angle

Push the syringe all the way into your pinched skin fold to inject insulin

3. Push the syringe all the way into the pinched skin fold, then push the plunger all the way down to deliver insulin into the fatty tissue

To inject insulin, withdraw the needle from your skin at the same angle that it was inserted

4. Withdraw the needle from the skin at the same angle that it was inserted and then release the skin fold

How to use an insulin pen

Insulin pen

How to prepare an insulin pen for injection

1. For cloudly insulin roll the pen in between your palms in a horizontal motion 10 times

To prepare an insulin pen for injection clean the rubber membrane with an alcohol swab

2. Clean the rubber membraine with an alcohol swab before attaching the insulin needle onto the insulin pen

To prepare an insulin pen for injection dial 2 units by turning the dose selector

3. Dial 2 units by turning the dose selector

To prepare an insulin pen for injection hold it with the needle upwards and tap the cartridge gently

4. Hold the insulin pen with the needle upwards and tap the cartridge gently with your finger a few times to let air bubbles collect at the top of the cartridge

To use the insulin pen, press the push-button all the way and a drop of insulin should appear

5. With the insulin pen still pointing upward, press the push button all the way (in the dose selector should return to "0", and a drop of insulin should appear at the needle tip)

To use the insulin pen for injection, select the dose you need

6. Select the dose of insulin you need

How to inject insulin with an insulin pen

1

Wash your hands with a soap and water

2

Dry hands with a tissue paper or hand towel

3

Select the injection site at your abdominal area

4

Clean the chosen site with water and tissue

5

Wait for the site to dry

6

Pinch a skinfold using your thumb and index finger

7

Inject the insulin at 90 degrees perpendicular to the injection site

8

Inject the dose by pressing the push-button all the way in until '0'

To use an insulin pen, inject the dose by pressing the push-button

9

Keep the push-button down fully for at least 6 seconds (to ensure the full dose has been injected) and as you withdraw the needle from your skin

To use an insulin pen, keep the push-button down fully to make sure full dose has been injected

10

Place the outer needle cap on the table. Direct the needle tip into the outer needle cap without holding on to it (to prevent finger stick injury). Unscrew and dispose the needle after it covered

To unscrew and dispose of the needle from an insulin pen safely, place the outer needle cap on the table

11

Store the insulin pen at room temperature after injection, away from direct sunlight and heat

Where to inject insulin

Insulin Sites

Suitable sites for insulin injection

Visual guide to show where you can inject insulin

You can inject insulin in your abdomen, arms, buttocks and thighs

To note

Different sites absorb insulin at different rates. Insulin is absorbed the fastest in the abdomen and slowest in the thighs
Rotates sites (e.g right and left thigh) to avoid swelling as this may affect insulin absorption

Site rotation

Rotate insulin injection sites every 1 to 2 weeks to avoid swelling

Move 2 fingers along from your last insulin injection site

Rotate injection sites by moving 2 finger's breadth along from your last injection site until you have used an entire area
Move to a new injection area every 1 to 2 weeks

Storage and disposal of insulin

Insulin storage

Quick tips on storing and handling your insulin

Write the date you open the insulin vial for proper storage and handling

1. Write the date on the vial on the day you open it

Store open insulin pens or vials at room temperature for proper storage and handling

2. For open vials or pens, store them at room temperature and away form direct sunlight

Store unused insulin pens or vials in the fridge for proper storage and handling

3. For unused vials or pens, store them in the fridge, not the freezer

For proper handling, avoid shaking the insulin vial excessively to prevent air bubbles forming

4. Avoid shaking the insulin vial excessively to prevent air bubbles forming

Discard the insulin 30 days after opening, if contaminated, if there are insoluble particles or if expired

5. Discard the insulin if expired (30 days after openning), contaminated, or if there are insoluble particles

How to safely dispose of used syringes and insulin pen needles

Proper disposal protects cleaners from accidental injuries, and prevents your used syringes and insulin pen needles form falling into the wrong hands

Place used syringes and insulin pen needles in a container to safely dispose of them

1. Place used syringes and insulin pen needles in a hard puncture-resistant container with a securable lid

2. Label the container "Used syringes and insulin pen needles"

Seal the container when it is full for safety

3. Seal the container when it is full

Discard the container down the rubbish chute for safety

4. Discard the container down the rubbish chute or in a rubbish bin

To note: Discard all used syringes and insulin pen needles do not reuse them. Containers that are suitable for safe disposal must be hard plastic, metal or sharp container, such as an empty detergent bottle or metal tin

Brought to you by

CONTRIBUTED BY

Ministry of Health