How should I inject?
- Learn how to inject properly
- Rotate injection sites
- Test blood glucose levels as recommended
- Make sure your hands and the area you’re injecting are clean.
- Eject two units of insulin into the air to make sure the tip of the needle is filled with insulin (this is called an ‘air shot’).
- Choose an area where there is plenty of fatty tissue, such as the tops of thighs or the bottom.
- If you have been advised to, lift a fold of skin (the lifted skin fold should not be squeezed so tightly that it causes skin blanching or pain) and insert the needle at a 90° angle. With short needles you don’t need to pinch up, unless you are very thin. Check with your diabetes healthcare team.
- Put the needle in quickly. If you continue to find injections painful, try numbing an area of skin by rubbing a piece of ice on the site for 15–20 seconds before injecting.
- Inject the insulin, ensuring the plunger (syringe) or thumb button (pen) is fully pressed down and count to 10 before removing the needle.
- Release the skin fold and dispose of the used needle safely.
Remember to use a new needle every time. Reusing a needle will make it blunt and can make injecting painful.
- Why do I need to rotate injection sites? If you keep injecting into the same area (and site) small lumps can build up under the skin. They don’t look or feel very nice and they make it harder for the body to absorb and use the insulin properly. So it’s important that you change the spot that you use each time.
- Will it hurt? The needles used are very small and you inject under the skin (subcutaneously) and not into a muscle or vein. At first, the injections may be a little painful or uncomfortable – this is usually because you are tense or anxious. But as your confidence grows, they will get easier and soon they’ll become second nature.
- Who will teach me? Someone from your diabetes healthcare team, usually the diabetes specialist nurse, will teach you how and when to inject and work with you to find the right insulin.
- What should I do with my needles and lancets when I have used them? Always dispose of them in a special sharps disposal bin and not in your normal rubbish bin. Sharps disposal bins and needle clippers are available for free on prescription and are designed to keep people safe from harm.
- What happens when my sharps disposal bin is full? Arrangements differ across the UK so please speak to your diabetes team to find out what you need to do.
All insulin needs to be kept at temperatures lower than 25°C/77°F, ideally between 2 and 6°C/36 and 43°F. Normal room temperatures are below 25°C but they can be warmer in the summer. Therefore any insulin you are not currently using should be stored in the fridge – throughout the year. Don’t put it in – or too close to – the freezer compartment, as the insulin may be damaged. Any insulin that has been out of the fridge for 28 days or more should be discarded.
Some insulins have slightly different storage needs, so always read the patient information leaflet that comes with yours.
Disposing of needles and lancets
The needles used for injecting insulin need to be disposed of carefully, to avoid the risk of injury or infection. You can dispose of your needles, syringes and lancets in a sharps disposal box. A clipper, a device that enables you to safely snap off sharps from your syringes/pens, can also be useful as a method of storage. The clipper needs to be disposed of in a sharps disposal box when full in accordance with your local guidelines for clinical waste disposal.
- Sharps disposal boxes and clippers are available on prescription (FP10 prescription form) in all four nations of the UK.
- There are different schemes and arrangements in place for the safe disposal of your sharps disposal box once it is full. Schemes vary from nation to nation and even down to the locality, and your local healthcare provider should have information about local disposal methods.
For more information, read our position statement on the safe disposal of sharps.
Moving onto insulin can be a very emotional time. Diabetes UK has a dedicated Careline if you need to talk to someone. Call 0345 123 2399 (Monday-Friday, 9am-7pm) or email firstname.lastname@example.org.
Type 1 diabetes results from the destruction of insulin-producing cells in the islets of the pancreas. Islet cell transplantation involves extracting islet cells from the pancreas of a deceased donor and implanting them in the liver of someone with Type 1. This minor procedure is usually done twice for each transplant patient, and can be performed with minimal risk using a needle under local anaesthetic.
As of 2008, the UK is fortunate to have the first government-funded islet transplant programme in the world. As of 2013, 95 islet transplants had been performed in 65 people in the UK. Islet cell transplants are now available through the NHS for people who satisfy the criteria given below.
When are islet transplants needed?
About one third of people with Type 1 diabetes each year will experience a ‘severe’ hypo – meaning that they need someone else to help them. Severe hypos can occur in anyone taking insulin, but they are more likely to occur in people who have had diabetes for more than 15 years and those who are unable to recognise when their blood glucose is low (a problem known as hypoglycaemic unawareness). For these people, an islet transplant can be a life-changing, and sometimes a life-saving, therapy.
Who might be suitable for an islet transplant?
- People with Type 1 diabetes who have experienced two or more severe hypos within the last two years, and have impaired awareness of hypoglycaemia.
- People with Type 1 diabetes and a functioning kidney transplant who experience severe hypos and impaired hypoglycaemia awareness or poor blood glucose control despite the best medical therapy.
Who might not be suitable for an islet transplant?
- People who need a lot of insulin (e.g. more than 50 units per day for a 70kg person).
- People who weigh over 85kg.
- People with poor kidney function.
What are the potential benefits?
Islet transplants have been shown to reduce the risk of severe hypos. Results from UK islet transplant patients showed that the frequency of hypos was reduced from 23 per person per year before transplantation to less than one hypo per person per year afterwards.
Islet transplants usually also lead to improved awareness of hypoglycaemia, less variability in blood glucose levels, improved average blood glucose, improved quality of life and reduced fear of hypos. Long-term results are good and are improving all the time. For example, the majority of transplant patients can now expect to have a functioning transplant after six years and some people have had more than 10 years of clinical benefit.
What risks are involved?
Islet transplants involve a small but increased risk of certain cancers, severe infections and other side-effects related to the medication needed to prevent the islets from being rejected by the body (which is the same medication used by people who receive other kinds of transplants).
Islet transplants are unsuitable for people who are desperate to stop their insulin injections. If freedom from insulin injections is achieved, this is usually short-lived, and most people who receive an islet transplant continue to take low-dose insulin therapy. Therefore, islet transplants should not be seen as a cure for diabetes
Find out more
If you think you might be eligible for an islet transplant, please read the detailed guide to islet transplants (PDF, 7MB) prepared by the UK Islet Transplant Consortium and discuss it with your diabetes healthcare team.
Who to contact
Referrals for islet transplant are being accepted by teams at seven centres across the UK. The doctors at each centre are very happy to discuss possible referrals and can be contacted directly.
Contact details for UK islet transplant centres.