From the Guidelines
Insulin Administration
Insulin should be administered subcutaneously, not intramuscularly or intravenously, to optimize glucose control and insulin use safety 1.
Proper Injection Technique
Proper insulin injection technique includes:
- Injecting into appropriate body areas, such as the abdomen, thigh, buttock, and upper arm 1
- Injection site rotation to avoid complications 1
- Appropriate care of injection sites to avoid infection or other complications 1
- Avoidance of intramuscular (IM) insulin delivery, as it can lead to unpredictable insulin absorption and variable effects on glucose 1
Insulin Regimens
Insulin regimens may include:
- Basal insulin, which is typically administered once or twice daily, with doses ranging from 10-50 units per injection 1
- Rapid-acting insulin, which is often administered before meals, with doses ranging from 2-10 units per meal 1
- Prandial insulin, which is administered to control blood glucose after meals 1
Transitioning to Subcutaneous Insulin
When discontinuing intravenous insulin, a transition protocol is recommended, which includes administering subcutaneous basal insulin 2-4 hours before the intravenous insulin is discontinued 1. The dose of basal insulin can be converted from the daily infusion dose at 60-80% 1.
From the FDA Drug Label
Administer subcutaneously into the abdominal area, thigh, or deltoid once daily at any time of day, but at the same time every day. Inject within 15 minutes before a meal or within 20 minutes after starting a meal into the abdomen, thigh, or upper arm. Administer by continuous subcutaneous infusion using an insulin pump in a region recommended in the instructions from the pump manufacturer. Administer only under medical supervision after diluting to concentrations from 0.05 to 1 unit/mL APIDRA in 0.9% sodium chloride injection, USP using polyvinyl chloride infusion bags.
The proper administration of insulin is:
- Subcutaneous: into the abdominal area, thigh, or deltoid once daily, or into the abdomen, thigh, or upper arm within 15 minutes before a meal or within 20 minutes after starting a meal.
- Continuous Subcutaneous Infusion: using an insulin pump in a region recommended in the instructions from the pump manufacturer.
- Intravenous: only under medical supervision after diluting to concentrations from 0.05 to 1 unit/mL in 0.9% sodium chloride injection, USP using polyvinyl chloride infusion bags 2, 3. Intramuscular administration is not mentioned in the provided drug labels.
From the Research
Administration of Insulin
The proper administration of insulin can be done through various methods, including:
- Subcutaneous injection: This is the most common method of insulin administration, where the insulin is injected into the fatty tissue under the skin 4, 5, 6.
- Continuous subcutaneous insulin infusion: This method involves using an insulin pump to deliver a continuous flow of insulin into the body 5.
- Intramuscular injection: This method is not recommended, especially with long-acting insulins, as it can cause severe hypoglycemia 4.
- Intravenous injection: This method is not typically used for routine insulin administration, but may be used in certain medical situations.
Key Considerations
When administering insulin, it's essential to consider the following:
- The type of insulin being used: Different types of insulin have different onset and duration of action, and may be administered at different times relative to meals 7, 6, 8.
- The individual's glucose levels and insulin needs: The dose and timing of insulin administration should be tailored to the individual's specific needs 4, 6.
- The risk of hypoglycemia: Insulin administration should be carefully managed to minimize the risk of hypoglycemia, especially when using long-acting insulins 4, 6.
- The use of insulin analogues: Insulin analogues, such as rapid-acting and premixed analogues, can offer improved glucose control and flexibility in injection timing compared to human insulin 7, 8.