Insulin Injection Technique Reference

1. Verify the order: insulin type, dose (in units), route, and timing. Confirm patient identity with two identifiers.
2. Check blood glucose: before every dose. Hold if BG < 70 mg/dL or below facility hold parameter — notify provider.
3. Perform independent double-check: a second nurse verifies type, dose, concentration, patient ID, and BG value at most facilities. Do not skip.
4. Inspect the vial or pen: check appearance appropriate for type (see below), expiration date, and that it is assigned to this patient. Never share insulin pens between patients.
5. NPH only — resuspend: gently roll the vial between palms 10–20 times. Never shake. Confirm the suspension is uniformly cloudy, not clumped or clear.
6. If mixing (Regular + NPH only): draw Regular (clear) first, then NPH (cloudy) — "clear before cloudy." Long-acting insulins must never be mixed.
7. Select syringe: use a U-100 insulin syringe for U-100 insulin. If U-500, a specific U-500 syringe and protocol are required — do not use a standard syringe.

1. Perform hand hygiene. Clean the selected injection site with an alcohol swab; allow to dry completely before injecting.
2. Pinch or lift the skin if the patient has little subcutaneous tissue (lean patients, injection near muscle). For most abdominal sites in adults, pinching is not required with short needles (4–6 mm).
3. Insert the needle at a 90° angle for most patients. Use a 45° angle for thin patients or pediatric patients to avoid intramuscular injection.
4. Inject the full dose slowly and steadily. Hold the needle in place for 5–10 seconds after injection to allow full dose delivery before withdrawing.
5. Withdraw at the same angle as insertion. Do not rub the site — rubbing can alter absorption rate.
6. Apply gentle pressure if there is bleeding; do not rub.
7. Dispose of the needle immediately in an approved sharps container. Do not recap.
8. Document the site used, dose, BG value, and patient response.

Systematic site rotation prevents lipodystrophy — fat tissue breakdown (lipoatrophy) or buildup (lipohypertrophy) at injection sites. Lipohypertrophy alters insulin absorption and makes glucose control unpredictable.

• Rotate within the same body region — inject at least 1 inch (2–3 cm) away from the previous site within the same region at each administration.
• Use consistent regions for each dose type — the abdomen absorbs fastest and most predictably; recommended for mealtime (prandial) insulin. Thigh or buttock for basal insulin provides slower, more stable absorption.
• Inspect and palpate sites — if a firm, rubbery area (lipohypertrophy) is felt, avoid injecting there until resolved. Absorption from lipohypertrophic tissue is erratic.
• Document the site — many facilities require injection site documentation at each administration. Use a rotation diagram if available.

Hypoglycemia (BG < 70 mg/dL) is the most immediate insulin-related risk. Always check BG before administering insulin. Know the signs and have a treatment plan ready.