What are the proper procedures for administering injections?

Proper Procedures for Administering Humalog Insulin Injections

The proper administration of Humalog insulin requires subcutaneous injection using a 4-mm pen needle inserted perpendicularly (90 degrees) to the skin, as this is the safest method that minimizes risk of intramuscular injection while ensuring optimal insulin absorption. 1

Preparation Before Injection

Site Selection

• Recommended injection sites: Abdomen, thighs, upper arms, and buttocks
• Rotation is critical: Systematically rotate within one area (e.g., within abdomen) rather than switching between different areas with each injection 1
• Avoid injecting into:
  • Lipohypertrophy (thickened tissue)
  • Areas of inflammation, edema, ulceration, or infection 1
  • Within 2 inches of the navel 1

Equipment Preparation

• Verify insulin label before each injection to avoid medication errors 1
• Clean hands and injection site before administration 1
• For pen devices:
  • Attach a new needle immediately before use
  • Never reuse needles
  • Perform an air shot (prime the pen) before each injection 2
• For vials:
  • Draw air equal to the insulin dose and inject it into the vial first to avoid creating a vacuum 1
  • When mixing insulins, draw the clear rapid-acting insulin (like Humalog) first 1

Injection Technique

Proper Needle Selection

• 4-mm pen needle is recommended for all patients regardless of age, sex, ethnicity, or BMI 1
• If using a syringe, a 6-mm needle is the safest option 1

Injection Method

1. Inspect the site before injection 1
2. For standard technique (most adults):
   • Lightly grasp a fold of skin
   • Release the pinch
   • Insert needle at 90° angle 1
3. For thin individuals or children:
   • Use a 4-mm needle with a lifted skinfold
   • Insert needle perpendicularly into the skinfold 1
4. Keep the needle embedded in the skin for 5 seconds after delivering the dose 1
5. Routine aspiration (drawing back to check for blood) is not necessary 1

Special Considerations

For Pregnant Women

• First trimester: No change in injection site or technique needed
• Second trimester: Use entire abdomen with properly raised skinfolds
• Third trimester: Use lateral abdomen with raised skinfolds or consider thigh, upper arm, or buttock 1

For Insulin Resuspension

• Rapid-acting insulins like Humalog do not need to be rolled or shaken 1
• For other insulin types (except rapid-acting and glargine), gently roll the vial or pen between palms to resuspend 1

Disposal of Sharps

• Place used needles and syringes in puncture-resistant containers 2
• Do not recap needles after use to avoid needlestick injuries 1
• Seal and properly dispose of sharps containers 2

Common Pitfalls to Avoid

1. Injecting into lipohypertrophy: This can lead to erratic insulin absorption and unpredictable blood glucose levels 1

2. Needle reuse: Increases risk of lipodystrophy, infection, and painful injections 1

3. Improper angle of injection: May result in intramuscular injection, which can alter insulin absorption and increase risk of hypoglycemia 1

4. Inadequate rotation of injection sites: Can lead to lipohypertrophy and variable insulin absorption 1

5. Improper pen technique: Releasing the thumb button while the needle is still in the skin can cause body fluid contamination of the cartridge 1

By following these evidence-based procedures for administering Humalog insulin, patients can achieve optimal glycemic control while minimizing complications related to injection technique.