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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Diabetes, Endocrine

Staying Healthy With Diabetes (6671)

Staying Healthy With Diabetes (6671) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Diabetes, Endocrine

6671






Staying Healthy
With
Diabetes
For: _______________





We care. We will listen. We can help.

1

















































2

Table of Contents





Table of Contents .......................................................................................................................... 2
About Diabetes .............................................................................................................................. 3
Blood Glucose Testing at Home ................................................................................................... 4
High and Low Blood Glucose (Sugar) Reactions ....................................................................... 5
Basics of Healthy Eating ............................................................................................................... 6
Staying Healthy to Avoid Complications of Diabetes ................................................................ 9
Oral Diabetes Medications (Pills) .............................................................................................. 11
Insulin and Non-Insulin Injectables .......................................................................................... 12
Steps to Draw Up and Inject Insulin ......................................................................................... 14
Frequently Asked Questions ...................................................................................................... 16
Your Insulin Action Plan ........................................................................................................... 17








Reference:
American Diabetes Association. Standards of Medical Care in Diabetes-2018. Diabetes Care.
2018;41(Suppl 1):S1-159.


Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright© 1/2018 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6671

3

About Diabetes

Types of Diabetes
ξ Type 1 diabetes means that your
body no longer makes insulin. It is
often diagnosed early in life but can
occur at any age. Insulin must be
taken to stay alive.
ξ Type 2 diabetes means that your
body does not respond to insulin as it
should. Over time, the body may
stop making enough insulin to keep
glucose levels controlled. When this
happens, insulin is needed. Type 2 is
the most common type of diabetes.
ξ Medication-induced diabetes
means that certain medications, like
steroids, can cause blood glucose
levels to rise above normal.
ξ Prediabetes means that blood
glucose levels are higher than normal
but not high enough to be diagnosed
with diabetes. If action is taken and
blood glucose levels are controlled,
type 2 diabetes can be delayed or
even prevented.

With all types, your body has a harder time
changing the food you eat into energy.
Glucose levels rise and you have less and
less energy. The glucose that stays in the
bloodstream can damage blood vessels
throughout the body over time. This can lead
to damage to your heart, eyes, kidneys, and
many other parts of your body.

Risk Factors for Type 2 Diabetes
ξ Over age 45
ξ Family history
ξ Ethnicity (African American, Latino,
Native American, Asian American
and Pacific Islander)
ξ Overweight
ξ Delivered a baby weighing more
than 9 pounds or have had
gestational diabetes
ξ Sedentary lifestyle
What the Numbers Mean
Diabetes is often diagnosed by checking
fasting blood glucose levels.
Normal: 70-99 mg/dL
Prediabetes: 100 – 125 mg/dL
Diabetes: 126 mg/dL or higher on two
tests or anytime glucoses are more than
200 mg/dL with symptoms

A1C and eAG
The A1C or hemoglobin A1C measures the
average amount of glucose in your blood
over the past 2-3 months. Studies show that
any decrease in A1C will help to reduce the
risk of long term problems from diabetes.
The chart below shows how the A1C relates
to the estimated average glucose or “eAG”.

A1C eAG (mg/dL)
Take Action
15 - 17 % 384 - 441
14 % 355
13 % 326
12 % 298
11 % 269
10 % 240
9 % 212
8 % 183
Goal 7 % 154
Diabetes 6.5 % 140
Pre-diabetes 5.7 -6.4 % 117-137


Talk with your health care team about how
often you need an A1C checked. It often
depends on your most recent result.

A1C eAG
My Goal
Last result
Next A1C
(date)



4

Blood Glucose Testing at Home

You can check your blood glucose levels at
home using a glucose meter. The results tell
you what your glucose levels are at certain
times of the day. Your meal choices,
activity, medicines, and how you feel will
affect the results.

There are many kinds of glucose meters. It
is best to find out which meter is covered by
your insurance.

Before testing, always wash your hands
with soap and water. You will poke your
clean finger for the blood sample. Apply the
drop of blood on a test strip and wait a few
seconds for the result.

Your Glucose Goals
Talk with your health care team about
setting goals that make sense for you. Use
the boxes below to record your goal.
*Source: American Diabetes Association (2018)

My Self-Testing Plan
How often you test your blood glucose
levels at home depends on your treatment
plan. Some people check a few times per
week. Others need to check four or more
times per day. Talk to your team about the
best times for you to test.

My Testing Schedule:
 Before meals  Bedtime
 2:00AM
 Before/during/after exercise
 Anytime you have signs or symptoms of
low or high blood sugar

Record your results in a logbook and/or
store results electronically. Bring your
logbook and/or meter to every clinic visit
for your health care team to review.

Testing on Sick Days
If you get sick with a cold or flu or if you
have an infection, you may need to check
your blood glucose levels as often as every
two hours. Stay in close contact with your
health care team during these times.
ξ Keep taking your diabetes pills or
insulin (if possible).
ξ Drink at least 4 oz (1/2 cup) of fluids
every 30 minutes.
ξ If you cannot eat a meal, then fluids
should contain sugar.

When to Call Your Doctor
ξ If you have had vomiting or diarrhea
for more than 6 hours
ξ If your glucose stays above 300
mg/dL for more than 6 hours or
below 70 mg/dL after repeated
treatment
ξ If you have moderate to large
ketones
Goals for People
with Diabetes* Your Goal
Before Meals:
80-130 mg/dL

_______ to _______

1-2 hours after
starting a meal:
less than 180 mg/dL
Less than ________
Bedtime/Before
Driving:
100-140 mg/dL

_______ to _______



5

High and Low Blood Glucose (Sugar) Reactions

Low Blood Glucose (Hypoglycemia)
Less than _______ mg/dL

Causes
ξ Too much insulin or diabetes pills
ξ Late/skipped meal or smaller than
usual meal
ξ More activity/exercise than usual
ξ Alcohol intake without food

Symptoms (happen quickly)
ξ Shaky, sweaty or clammy
ξ Light-headed, weak, blurry vision
ξ Hungry, irritable, anxious or
confused

These are the most common symptoms.
Get to know your symptoms and act
quickly. If not treated quickly, you may
lose consciousness.

Treatment Options (if able to swallow)
Get treatment quickly. Take 15 grams of
quick-acting carbohydrate (sugar).
Examples:
ξ 4 oz. (½ cup) juice or regular (non-
diet) soda
ξ Glucose liquid or gel (read label for
amount)
ξ 4 glucose tablets (chew them)
ξ Soft, chewable candy (amount
varies)

Check your blood glucose 15 minutes after
treatment. If your glucose is still below 70
mg/dL, repeat treatment.
Call 911 if you feel too sick to eat or if the
glucose levels stay below 80 mg/dL after 30
minutes.
Informing Others
It is important to wear a Medical Alert
bracelet or necklace that is easy to see by
others. Carry a wallet card that states that
you have diabetes.

High Blood Glucose (Hyperglycemia)
More than _______ mg/dL

Causes
ξ Not enough or missed dose of insulin
or diabetes pills
ξ Less activity than usual
ξ Overeating
ξ Illness (cold, flu, infection)
ξ Pain or injury
ξ Stress (physical or emotional)
ξ Some medicines (such as steroids)

Symptoms (happen over time)
ξ Thirst, frequent urination
ξ Nausea/vomiting
ξ Unexplained weight loss
ξ Slow healing or frequent infections
ξ Fatigue or sleepy
ξ Blurred vision

Many people do not have symptoms until
glucose levels are very high, but this varies
for each person. If not treated, high blood
sugars can be life-threatening.

Prevent High and Low Blood Glucoses
ξ Know what causes your low and high
blood glucose levels and take steps to
prevent those causes.
ξ Test your glucose levels as advised by
your health care team. Know your target
glucose levels.
ξ Keep a log of your results. If you notice
patterns of high or low glucose levels,
call your doctor or nurse to discuss.
ξ Take your insulin or diabetes pills as
prescribed. If you think the doses are a
cause of your low or high blood glucose
levels, talk with your health care team.
ξ Follow your meal plan. Do not skip
meals and avoid overeating.
ξ Check your blood sugar before exercise
and before driving. Eat a snack if
needed.

6

Basics of Healthy Eating

ξ Aim to eat meals and snacks at about
the same time each day. Avoid
skipping meals. This will prevent
you from getting too hungry and
overeating.
ξ Eat breakfast every day. Healthy
examples: 1 piece of whole grain
toast and an egg, or yogurt and a
piece of fruit, or a small bagel with
peanut butter.
ξ Choose a variety of foods at each
meal to help your body get the
nutrients it needs.
ξ Use a 9” plate to help you pay
attention to portion sizes. Fill ½ of it
with fruits and vegetables, ¼ with
protein, and ¼ with grains.

ξ Eat high-fiber foods. Aim for:
o 3 grams or more of fiber per
serving
o 25 – 35 grams of fiber per day
ξ Limit foods high in fat. Use foods
with less saturated and trans fat,
sugar and sodium.
ξ Choose lower calorie options when
you eat out. Share a meal or bring
home left-overs to control portions.
ξ Use jams, jellies and syrup made
with low sugar or no sugar.
ξ Choose unsweetened drinks such as
black coffee, diet soda, or drinks
with an artificial sweetener. Use
unsweetened canned fruits in natural
juices.
ξ If you need to lose weight, eat
smaller portions and become more
active!
o Losing 5-10 pounds can improve
your blood glucose levels, blood
pressure, and cholesterol.
o Start by cutting out 100 calories a
day (8 oz regular soda, 1 Tbs.
Butter, margarine or regular
salad dressing).
o Walk 10 minutes more each day.
Small changes count!

Carbohydrates
Foods contain carbohydrates, proteins, and
fats. All three are part of a well-balanced
meal plan. Carbohydrates raise blood sugar
while protein and fat do not.

You still need to eat carbohydrates for many
reasons.
ξ They are a good source of energy for
the body, especially the brain and red
blood cells.
ξ They can be a great source of fiber,
vitamins and minerals.
ξ They taste good!

Examples of Carbohydrates
ξ Breads, cereals, rice, and pasta
ξ Starchy vegetables (white and sweet
potatoes, corn, green peas, and
winter squash) and legumes (dried
beans, lentils, and split peas)
ξ Fruits and fruit juice
ξ Milk and yogurt
ξ Sweets and snacks such as cakes, ice
cream, cookies, chips, and pretzels
ξ Regular sodas, jelly, syrup, honey,
and table sugar



7

Carbohydrate Counting
Carbohydrate (“carb”) counting is a method
of meal planning. It is used to help improve
glucose results. It is not a special diet, nor
does it cut out any of your favorite foods. In
fact, it is just a way to keep track of the
foods you eat that contain carbohydrate.

Getting Started
Aim for consistent carbohydrate amounts
with meals and snacks. This should help you
meet your blood glucose goals.

Generally, adults with type 2 diabetes,
eat:
ξ 135-180 grams per day
ξ 45-60 grams per meal
ξ 15-30 grams per snack

Food Labels
ξ Read food labels carefully. Be sure
to look at the serving size and the
Total Carbohydrate line. You don’t
need to look at the grams of sugar
because they are included in the
Total Carbohydrate grams.
ξ Sugar-free foods may still contain
carbohydrate, so be sure to check the
total carbohydrate content.
ξ Sugar alcohols like sorbitol or
mannitol are used in sugar-free gum
and candy. Sugar alcohols can cause
stomach cramping or diarrhea if used
in large amounts.
ξ Foods with less than 20 calories or
less than 5 grams of total
carbohydrate per serving will have
little effect on your blood sugar
levels, if used in small amounts.

Working with a Dietitian
One of the first things to do is decide on a
meal plan with a dietitian. Based on your
usual intake, weight, height, activity level,
and age, he or she will suggest how many
carbohydrate servings you should have each
day and how to divide them between meals
and snacks.











8

Serving Sizes and Carbohydrate Content

Grains, Beans and Starch
Vegetables
Portion
Size
Total
Carbohydrate (g)
Beans (black, garbanzo,
kidney, navy, etc.), cooked
or canned
½ cup 15
Bread, any kind 1 slice (1
oz)
15
Bun, hamburger or hot dog 1 25-30
Cereal, cooked ½ cup 15
Cereal, unsweetened, dry ¾-1 cup 20-30
Corn 1/2 15
Crackers, graham 2 squares 10
Crackers, saltines 4 squares 9
Pasta, cooked 1/2 cup 22
Peas ½ cup 15
Potato, cooked ½ cup 15
Rice, cooked 1/2 cup 22
Tortilla, flour, 8” 1 25

Fruits
Portion
Size
Total
Carbohydrate (g)
Apple 1 medium 22
Banana 1/2-1 15-30
Berries (strawberries,
blueberries, raspberries)
1 cup 15-20
Canned fruit in juice ½ cup 14
Canned fruit in heavy syrup ½ cup 23
Grapes 1 cup 27
Juice (grape, cranberry,
prune)
1/3 cup 15
Juice (apple, orange,
grapefruit)
1/2 cup 15

Milk and Yogurt
Portion
Size
Total
Carbohydrate (g)
Milk, 1% and fat-free 1 cup 13
Milk, 2% and whole 1 cup 12
Yogurt, fruited, sweetened 6 oz cup 25-35
Yogurt, light, fat-free,
artificially sweetened
6 oz cup 15-20
Foods You Eat






9

Staying Healthy to Avoid Complications of Diabetes

High blood glucose levels over time can cause damage to your blood vessels, eyes, kidneys, nerves,
and feet. This means you can be at risk for heart attack, stroke, blindness, kidney disease, and loss of
toes and limbs. Review the chart below for things you can do to lower your risk of these problems.

What You
Need
How Often Reason Goal
A1C Test Every 3 or
6 months
Know if blood sugar levels are in
your goal range
< 7% for most people
If you do not know your A1C
goal, ask.
Urine
Microalbumin
/Creatinine
Ratio Test
Yearly
Check the health of your kidneys.
High blood sugar levels and high
blood pressure damage blood
vessels in the kidneys.
< 30 mg/L
Cholesterol Test
Every 5
years or
more often
as needed
If cholesterol levels are not in
goal range, discuss changes that
could help reduce risk of stroke,
heart attack, kidney and eye
problems.
Triglycerides: < 150
LDL: < 100
HDL: > 40 for men; > 50 for
women
Blood Pressure
Check Each Visit
If blood pressure is not in goal
range, discuss changes that could
help reduce risk of stroke, heart
attack, kidney and eye problems.

< 140/90 for most
<130/80 for some
Clinic
Appointment
Every 6
months or
more often
if needed
Discuss your test and exam
results, home blood sugar
readings, alcohol intake, smoking
habits, exercise and any concerns
you have.

Set or revise personal health
goals
Dilated Eye
Exam
Every 1-2
years
Check for small blood vessel
damage in the back of the eyes
Prevent eye problems that can
affect vision and lead to
blindness
Dental Exam Every 6 months
Check for tooth or gum problems Prevent gum problems and tooth
decay
Complete Foot
Exam Yearly
Check nerve function, circulation,
and any nail or skin problems
Prevent ulcers and amputation of
toes, feet, legs
Flu/Pneumonia
Vaccinations
As needed;
ask your
doctor
To protect against illness Prevent high blood sugar levels
due to illness
Diabetes
Education
When
diagnosed
and yearly
Learn about how to stay healthy
with diabetes; help you set
personal health goals
Attend a class taught by
dietitians and/or nurses who are
certified diabetes educators
(CDE); include family or support
persons to learn with you


10

Other Healthy Choices

Regular check-ups and immunizations go a
long way in keeping you healthy. There are a
number of other things you can do as well.

Activity
Activity helps control your blood glucose
levels. Here are some key points to follow:
ξ Have a check-up first!
ξ Start gradually.
ξ Set goals.
ξ Choose activities you enjoy.

Safety First
ξ Test blood glucoses before and after
activity. Low blood glucose can
happen hours later.
ξ Always warm up and cool down.
ξ Keep water nearby to stay hydrated.
ξ Be prepared to treat low blood
glucoses.
ξ Carry identification.

Foot Care
ξ Wear well-fitting shoes and socks.
ξ Look at your feet daily. If you have
trouble seeing your feet, use a mirror or
ask a family member to look for you.
ξ Be sure to report any signs of cuts,
sores, redness, or drainage.
ξ Ask for help from your doctor if you
need help cutting your nails. You might
need help from a podiatrist (foot
doctor).

Tobacco Use
If you use tobacco, there are some key things
to know that relate to diabetes.
ξ Smoking raises your blood sugar levels
AND lessens your body's ability to use
insulin. Smoking ONE cigarette lowers
the body's ability to use insulin by
15%.
ξ People with diabetes who smoke are
twice as likely to have circulation and
wound healing problems.
ξ You are 11 times more likely to die of
a heart attack or stroke if you have
diabetes and smoke.
ξ Smokers with diabetes are more likely
to get nerve damage and kidney
disease.
Make a Quit Plan
ξ The best way to quit is to combine
medicines with counseling and/or the
Tobacco Quit Line. Using both makes
successful quitting four times more
likely!
ξ Tobacco users can call toll free, 1-800-
QUIT-NOW (800-784-8669) to talk to
counselors about how to quit. The calls
are private and advice is tailored to
each person.

Managing Your Emotional Health
Dealing with diabetes or any chronic condition
can be overwhelming. Be sure to find others
who can provide support. This might include
family, friends, and your diabetes care team.
Find ways to manage the stress you might
have. Emotional stress can even affect your
blood glucose levels.

Ways you deal with stress:
__________________________________
__________________________________
__________________________________
__________________________________

If you are feeling helpless or hopeless, or have
trouble sleeping or eating, talk with your
provider. These can be signs of depression.




11

Oral Diabetes Medications (Pills)

There are many medications taken by mouth for high blood glucose. These may also be called
“oral agents.” They are used along with healthy eating and exercise. Some of them are listed
below. If oral agents are prescribed for you, be sure to find out more about how each one works.

Medicine Names How It Works A1C Effect Notes
Biguanides
Examples:
ξ Glucophage® (metformin,
regular release)
ξ Fortamet®, Glucophage
XR®, Glumetza®
(metformin extended
release)
ξ Help muscle cells
use sugar
ξ Lower the amount
of glucose your
liver makes
ξ Lower how much
sugar your body
absorbs from the
food you eat
1-2% ξ Take with food to
decrease side effects of
upset stomach, diarrhea
ξ Must swallow extended
release tablets whole
ξ May need to stop for
surgery, certain scans or
x-rays
Sulfonylureas
Examples:
ξ Amaryl® (glimepiride)
ξ Glucotrol® (glipizide)
ξ Glucotrol XL® (glipizide
Extended Release)
ξ Diabeta®, Micronase®
(glyburide)
ξ Help your
pancreas make
more insulin

1-2% ξ Can cause low blood
sugars
ξ Do not take if you will
not be eating within 30
minutes
ξ Avoid with sulfa allergy
Dipeptidyl Peptidase-4
(DPP-4) inhibitors
Examples:
ξ Onglyza® (saxagliptin)
ξ Januvia® (sitagliptin)
ξ Tradjenta® (linagliptin)
ξ Raise the amount
of insulin your
body makes after
you eat
ξ Lower the
amount of
glucose the liver
makes
0.4 – 0.8% ξ Do not cause weight gain


Thiazolidinediones (“TZDs”)
Examples:
ξ Actos® (pioglitazone)
ξ Avandia® (rosiglitazone)
ξ Help muscles use
glucose
ξ Lower the
amount of
glucose the liver
makes
1-1.5% ξ Can cause swelling and
weight gain
ξ Should not be used for
people with heart failure
ξ Discuss other risks/
restrictions with provider
Sodium-Glucose Co-
transporter 2 (SGLT2)
Inhibitor
Examples:
ξ Invokana® (canagliflozin)
ξ Farxiga® (dapagliflozin)
ξ Jardiance® (empagliflozin)
ξ Help remove
glucose from the
body through the
urine

0.5-1% ξ Take before the first meal
of the day
ξ Likely to have increased
urination
ξ More risk for urinary tract
and fungal infections



12

Insulin and Non-Insulin Injectables
Insulin is used when a meal plan, exercise,
and oral agents are not enough to control
your blood glucose levels. If you have
type 1 diabetes or your pancreas has been
damaged or removed, insulin must be used.
The chart below tells you more about how
different insulins work. Onset means how
long it takes to start to work. Peak means
when it works at its best. Duration means
how long it affects your blood sugars.
Other treatment options may be prescribed
for adults with type 2 diabetes. Exenatide
(Byetta®, Bydureon®), liraglutide
(Victoza®), and dulaglutide (Trulicity®) can
lower blood glucose levels. These medicines
are not insulin, but must be injected. If you
have questions, please ask your team who
can give you more details.

Expiration
Using expired medicine will affect your blood
sugar control. Key points:
ξ Check your vials for an expiration
date. Use this date if the vial has not
been opened yet.
ξ Mark the date you start to use a vial or
pen. Once in use, insulin expires
whether or not you refrigerate or store
at room temperature.
ξ Do not refrigerate insulin pens after
first use unless instructed to do so.

Expiration dates for vials
ξ Levemir®: 42 days
ξ All other insulin types: 28 days


Expiration dates for insulin pens
ξ NPH: 14 days (disposable) or 7
days (cartridge)
ξ Levemir® and Toujeo®: 42 days
ξ Tresiba®: 56 days
ξ 70/30, 50/50, 75/25: 10 days
(disposable) or 7 days (cartridge)
ξ All other insulin types: 28 days

Expiration dates for non-insulin injectables
ξ Byetta® (exenatide): 30 days
ξ Bydureon® (exenatide XR): 28 days if
stored at room temperature
ξ Victoza® (liraglutide): 30 days
ξ Ozempic® (semaglutide): as directed
ξ Trulicity® (dulaglutide): as directed
Insulin Name Onset Peak Duration Key Points
Novolog®(aspart)
Humalog® (lispro)
Apidra® (glulisine)
Humalog® U-200
5-15
minutes
1-2
hours
4-6 hours
Take within 10 minutes before or after
eating.
Regular 30-60 minutes
2-4
hours
6-10 hours
Take within 30 minutes of eating.
NPH 1-2
hours
4-8
hours
10-20
hours
This insulin is cloudy. Always roll the
vial or pen before using.
Detemir (Levemir®) 1-2
hours
8-12
hours
12-24
hours
Never mix in the same syringe with any
other insulin.
Degludec
(Tresiba® U-100/U-200) 1 hour
12
hours
42+ hours
Only available in a pen (no vials)
Glargine
(Lantus®/Basaglar®)
1-2
hours
None 24+ hours Never mix in the same syringe with any
other insulin.
Glargine U-300 (Toujeo®) 6 hours None 36 hours Only available in a pen (no vials)



13


Correction Insulin


Correction insulin is meant to “correct” or
lower high blood sugars before meals. It is
often given in addition to the usual dose
that you take to cover your meal. Some
people also take it if blood sugars are high at
bedtime.

Types of Correction Insulin
Short-acting or rapid-acting insulin can be
used. Examples include:
ξ Regular
ξ Novolog® (aspart)
ξ Humalog® (lispro)
ξ Apidra® (glulisine)

My Insulin Type: ______________

Key Points
ξ Do not eat less food because of the high
blood sugar. This can put you at risk for
low blood sugars.
ξ Do not take correction insulin more
often than every 4-6 hours unless you
have been told to do so.
ξ If you need to use correction insulin
daily, for three or more days in a row,
call your health care team. Your usual
doses may need to be changed.
ξ Exercise will likely lower your blood
sugars. You may not need correction
insulin at the meal before or after you
exercise. Discuss this with your health
care team.
My doses as of this date __________ are:


Example
Your blood sugar before lunch is 285 mg/dl.
Your usual dose is _____ units.
Your correction dose is _____ units.
Total Dose = _______

Before Meals
If Blood Glucose is:
Add this much
extra insulin:
Less than 150 mg/dL

No extra insulin
151 - 200 units
201 - 250 units
251 - 300 units
301 - 350 units
351 - 400 units
Before Bedtime
If Blood Glucose is:
Add this much
extra insulin:
Less than 200 mg/dL No extra insulin
201 - 250 units
251 - 300 units
301 – 350 units
351 - 400 units
More than 400 units


14

Steps to Draw Up and Inject Insulin


Needle Disposal
Drop the used syringe or pen needle into the
“Sharps Box” or other hard plastic
container. Close the lid and move the box
out of the reach of children and pets. For
more information visit,
http://www.fda.gov/safesharpsdisposal.

Injection Sites
Insulin injections are given into fatty tissue.
Areas of fatty tissue are shaded in the image
below.

Abdomen: If using this
site, do not use the area
within one inch of your
belly button. Avoid
using the belt line area
since rubbing may
irritate the site. Avoid
scars from surgery.

Arms: Use the back side of your upper arm
in the fatty tissue. It can be hard to reach this
area yourself. You can try pinching up the
tissue by placing your arm over the back of
a chair or brace it against a wall.

Thighs: Use middle and outer areas where
you can pinch up tissue.

Buttocks: Use any area where you can
pinch up tissue. This site is not often used
since it’s hard to reach.

Site Rotation
Rotate your injection sites to prevent tissue
damage. If tissue is damaged, the insulin
may not absorb as well. This may make it
harder to control your blood sugars. Some
people keep a record of where their last shot
was given to avoid these problems. If you
choose one site, like the abdomen only, be
sure to rotate shots within that site.

15

Drawing Up Two Types of Insulin
If you need two types of insulin at the same
time of day and prefer to inject once, you
may be able to combine them in one syringe.
See the key points below.

(Not all insulin types can be mixed. Be sure
to ask your health care team if it makes
sense to mix the insulin types you take.)

Key Points:
 Inject air into both vials before
drawing up insulin.
 Always draw up your clear insulin
before the cloudy insulin.
 If you draw too much cloudy insulin,
discard the syringe and start again.

Drawing Up Insulin Before Dose Is
Needed
 NPH and Regular insulin can be pre-
filled up to 21 days before using.
 Keep these pre-filled syringes in the
refrigerator with the needle tip
pointed upward. Rotate the syringe
to mix the two insulins before using.
 If NPH and rapid-acting insulin are
mixed in the same syringe, give the
dose as soon as you can after
drawing it up.
 Glargine should not be pre-filled.
Inject it as soon as you can after
drawing it up.

Using Pens or Devices
Insulin and other medications can be given
using devices that may be shaped like pens.
(See image below.) You can “draw up” your
dose by turning a dial to the amount you
need. Some people find this is easier than
using a syringe. Pens may cost more, so be
sure to discuss this with your health care
team.

Steps for Using an Insulin Pen
1. Wash your hands and be sure your
injection site is clean.
2. Check the label on the pen to make sure
you are using the correct type of insulin.
3. Clean the rubber stopper on your pen by
rubbing it with an alcohol wipe.
4. Remove the foil seal on the pen needle.
Attach the pen needle to your pen by
twisting it on the end of the pen until
tight.
5. Pull off the outer pen needle cap and
inner pen needle cap. Set aside.
6. Prime the pen by dialing in 2 units (of 5
units if using U-500 pen). Hold your pen
with the needle pointing up. Push the
end of your pen like a plunger to push
out the 2 units. You should see a drop of
insulin at the needle tip. If not, repeat
this step. (Do this priming step each time
you attach a new needle.)
7. Turn the dial to the number of insulin
units you need.

8. Locate the injection site. Inject the pen
needle into your skin at a 90 degree
angle as shown in the picture.
9. Push the end of your pen
down all the way until
pen dose reads “0”.
10. Wait 5-10 seconds
before pulling the pen
out of your skin.
11. Withdraw the pen and
pen needle from your
skin.
12. Unscrew and remove the
pen needle.
13. Throw your used pen
needle in a sharps box.

Source of images: Media Solutions, UW School of
Medicine and Public Health. Permission for use
granted by the Wisconsin Diabetes Prevention and
Control Program.



16

Frequently Asked Questions

We expect that you will have questions as
you learn more about insulin. The questions
below are a few that are often asked.

Sometimes, a little insulin leaks out of the
skin after my shot. Should I repeat the
dose or give a little more?
Do not give more insulin – there is no way
to guess the amount that leaked out. When
giving the next dose, leave the needle in the
skin for a few seconds after injecting. If you
are using a pen instead of a syringe, make
sure to leave the needle in the skin and count
to 10 before pulling out the needle.

What should I do if I draw up/dial up the
wrong dose?
If you are using a vial and syringe, and only
one type of insulin, you can push the insulin
back into the vial until you are at the correct
dose. If you are using a pen, make sure to
turn the dial back to zero (0). Do not push
the dialed end in if there is no pen needle
attached. The pressure created may cause
damage. Never dial in a dose of insulin
without a pen needle attached.

What if I forget to take my insulin?
If you are taking only one injection of
insulin a day, you may take your shot if you
remember before going to bed. If you forget
at night, do not take a dose the next
morning. Just take your prescribed dose the
next evening. Expect your blood glucose
readings to be higher during the day after no
insulin.

What if there is air in my syringe?
With the needle pointing up, “flick” the
syringe to move the air bubble to the top.
Then push the plunger up to force the air
out. Draw up more insulin if needed to get
the dose you need. If you inject air into
yourself, the air will not hurt you, but you
will not get your full dose of insulin.

What if there is air in my insulin pen?
Sometimes air gets into the insulin in your
pen. This often happens when a pen needle
is left on the pen during storage. Always
remove the pen needle after you have given
your shot. If air is present in the insulin,
attach a pen needle, dial up 2 units and hold
the pen straight up and down with the needle
pointing up. Push the dialed dose in – to
shoot out the air. Repeat 2 units until a drop
(or spray) of insulin comes from the tip of
the needle.

What if I can’t see to draw up my dose of
insulin? There are magnifiers available for
syringes and for some pen devices. You may
also choose to have a family member or
friend draw up syringes of the correct dose
ahead of time.

Where should I throw away my needle?
Needles should be disposed of in a hard
plastic jug, like a laundry detergent bottle. A
red “Sharps Box” can be used if you prefer.
These can be purchased at any pharmacy.
Some laboratories will accept needles that
are in a hard plastic container.

Can I mix my insulin before I need it?
ξ NPH and Regular insulin can be pre-
filled up to 21 days before using.
ξ Keep these pre-filled syringes in the
refrigerator with the needle tip
pointed upward. Rotate the syringe
to mix the two insulins before using.
ξ If NPH and Novolog® or NPH and
Humalog® are mixed in the same
syringe, these doses should be given
right after filling the syringe.
ξ Glargine should not be pre-filled.
Inject it as soon as you can after
drawing up your dose.







17

Your Insulin Action Plan

Doses may change when you leave the hospital or after a clinic visit. Please use the most
recent orders from your doctor and/or refer to your discharge paperwork.


Date: __________________ (Please update as changes are made.)

Blood Sugar Goals: _____________ (before meals) ____________ (at bedtime)

Testing Schedule:  Before meals  Bedtime  2:00AM  Before/during/after exercise
 Anytime you have signs or symptoms of low or high blood sugar

Type of Insulin Breakfast Lunch Dinner Bedtime
Long-acting insulin:
(basal)

______ units ______ units ______ units ______ units
Meal time insulin:
(bolus)

______ units ______ units ______ units
 Skip usual meal dose if you skip a meal.
 Take ½ of your usual meal dose if you eat less than half of your meal.
Correction insulin: With meals?  Yes  No
At Bedtime?  Yes  No
(See below for doses)


Correction Insulin
Note: If you need to use correction insulin daily, for 3 or more days in a row, call your health
care team. Your usual doses may need to be changed.


We hope this booklet will help you to stay healthy with diabetes. We know it can be
overwhelming at times. Remember…We care. We will listen. We can help.
With Meals
If Blood Glucose is:
Add this much
extra insulin:
Less than 150
mg/dL
No extra
insulin
151 - 200 units
201 - 250 units
251 - 300 units
301 - 350 units
351 - 400 units
At Bedtime
If Blood Glucose is:
Add this much
extra insulin:
Less than 200
mg/dL
No extra
insulin
201 - 250 units
251 - 300 units
301 – 350 units
351 - 400 units
More than 400 units