Siabetics requirements can be estimated based upon a patient's body Natural chia seeds algorithm 1. If your blood sugar is Blood sugar management for diabetics, you riabetics to know how suggar bring sugzr down. Each Visit Date Result Foot check Review self-care plan Weight check Review medicines Once a Blood sugar management for diabetics Date Result Sgar exam Idabetics eye diabdtics Complete diabetkcs exam Flu shot Kidney check At Least Once Date Result Pneumonia shot Hepatitis B shot Self Checks of Blood Sugar How to use this card. The obvious concern when using U insulin with a Tuberculin syringe is the potential for confusion of volume and units. Williams Textbook of Endocrinology. In addition, even when such a regimen is considered to be the ideal outpatient therapy upon discharge, the patient may not be able to comply safely with the prescribed insulin program, which requires a degree of education, commitment, and self-discipline not exhibited by all. It's very important to take charge of stress when you have diabetes.

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Blood sugar management for diabetics -

It is important to avoid hypoglycemia, even if the consequence is a temporary modest rise in the blood glucose concentration. Insulin can be given either subcutaneously or intravenously.

Algorithms for glycemic management of nonfasting and fasting patients with type 1 diabetes who are not critically ill are shown for subcutaneous dosing regimens algorithm 1 and algorithm 2 [ 13 ].

If the patient is receiving nothing by mouth, the administration of basal insulin is still required. As examples:. No boluses would be administered until the patient is able to eat. Since nursing staff are not always familiar or comfortable with the use of insulin pumps, patients should be alert enough to manage their pump therapy and possess sufficient vision and dexterity to safely use the device.

In addition, vigilance regarding pump catheter placement is necessary. Catheters may inadvertently be dislodged during transfers in the operating room or in bed, and if the patient is not alert enough to provide self-care, the health care providers should consider changing to conventional injection therapy until the patient is able to manage pump therapy again.

In patients with tightly managed glycemia, an alternative approach is to reduce the dose of glargine by 10 to 20 percent eg, give 16 to 18 units to minimize the risk of hypoglycemia that might require oral ingestion of calories and thereby delay the planned procedure.

Short-acting insulin should not be given, unless significant hyperglycemia is noted, as described above. Blood glucose should be measured every two to three hours until the first meal is eaten. Intravenous glucose at approximately 3.

See "Cases illustrating intensive insulin therapy in special situations". Patients receiving enteral or parenteral feedings — Patients with diabetes who are receiving total parenteral nutrition TPN or tube feeds bolus or continuous require special consideration.

TPN — In patients receiving total parenteral nutrition TPN , insulin may be administered as part of the nutritional solution, if allowed by the hospital pharmacy. To determine the correct dose of insulin to add to the TPN fluid, a separate infusion of regular insulin can be used initially.

When glucoses have reached goal, the total daily dose of regular insulin provided by the insulin drip is calculated; 80 percent of this amount is added to the TPN fluid as regular insulin to be delivered over 24 hours.

For example, if the intravenous insulin infusion at steady state was set at 1 unit per hour or 24 units per day , around 80 percent of this amount 20 units should be added to the TPN solution by the pharmacy to be given over the course of the day.

The amount of insulin can then be titrated every one to two days, based upon glucose monitoring. Since more frequent adjustments are impractical and costly, the concurrent use of rapid- or short-acting insulin as correction every six hours will help to fine-tune glycemic management.

See 'Correction insulin' above. If TPN is interrupted, most patients with type 2 diabetes can be followed with careful glucose monitoring.

Insulin should be administered if hyperglycemia occurs. In patients with type 1 diabetes, hyperglycemia will occur and can result in ketosis if all insulin is withheld.

Thus, patients with type 1 diabetes require insulin when the TPN is interrupted. The amount and type of insulin depend upon the anticipated duration of the interruption. Because of the potential for inadvertent discontinuation of insulin therapy if TPN is interrupted, some clinicians recommend giving a portion of the basal insulin as an injection eg, 50 percent in patients with type 1 diabetes.

In the example above patient receiving 24 units of regular insulin a day, 80 percent of this amount [19 units] added to the TPN solution , approximately 10 units of regular insulin can be added to the TPN solution and 9 units of NPH, glargine, or detemir administered as a basal injection.

This approach can also be used in insulin-requiring patients with type 2 diabetes. Enteral feedings — In patients receiving continuous enteral feeds, the total daily dose of insulin could be administered as basal insulin alone once-daily glargine, detemir, or degludec, or twice-daily detemir or NPH.

However, if the enteral feeds are unexpectedly discontinued, hypoglycemia may occur. Thus, a safer approach may be to administer approximately 50 percent of the total daily insulin dose as basal insulin and 50 percent as prandial short- or rapid-acting insulin, which is given every four rapid-acting insulin to six short-acting insulin hours [ 33 ].

A similar ratio of basal-to-prandial insulin can be used for patients receiving bolus feeds, for whom the prandial insulin would be divided equally before each bolus feed. Correction rapid- or short-acting insulin can then be administered, as needed, with the prandial insulin same type.

In those receiving cycled enteral feeding eg, 8 to 10 hours overnight , the ideal insulin may be NPH, which has an activity profile similar to this duration, its effect waning when the feeds are stopped. Again, correction rapid- or short-acting insulin can then be administered as needed to optimize glycemic management.

Another approach is to use short-acting insulin alone. This approach is supported by the findings of a randomized trial of sliding-scale, regular insulin every four to six hours alone or in combination with insulin glargine in 50 noncritically ill patients with diabetes receiving enteral nutrition [ 34 ].

There were no differences in any glycemic measures mean study glucose, mean peak or nadir glucose, hypoglycemia events, or total daily insulin dose between the two groups.

However, NPH insulin was required in 48 percent of subjects randomly assigned to sliding-scale, regular insulin. Thus, when sliding-scale, regular insulin alone is chosen as the initial management strategy for patients receiving enteral feeds, the addition of basal insulin is often required to maintain adequate glycemic management.

Consultation — Most of the time, the treatment of hyperglycemia in patients with diabetes in these stressful circumstances can be done by the patient's internist, generalist, or hospitalist. However, each clinician needs to decide whether or not the patient would benefit from additional advice; consultation with a diabetes specialist or endocrinologist may help, particularly if accompanied by a team including personnel who can provide patient education and nutritional advice.

This team approach can decrease the patient's length of stay as well as decrease the total cost of care [ 35,36 ]. Using the hospitalization to enhance the patient's knowledge about the disease and to improve self-management is encouraged. Evaluation of overall care — A brief hospitalization is an excellent opportunity to assess or reassess overall care in patients with diabetes.

If appropriate, attention should be paid to preventive measures such as smoking cessation, hypertension management, treatment of dyslipidemia, and appropriate vaccinations [ 37 ], glycemic management, assessment of possible complications of diabetes, and overall patient education.

This assessment should lead to the formulation of a plan for future treatment after the patient is discharged. See "Overview of general medical care in nonpregnant adults with diabetes mellitus".

In type 2 diabetes, an insulin regimen may not be necessary after the illness requiring hospitalization has resolved. In addition, even when such a regimen is considered to be the ideal outpatient therapy upon discharge, the patient may not be able to comply safely with the prescribed insulin program, which requires a degree of education, commitment, and self-discipline not exhibited by all.

Thus, it is important to determine both the insulin needs as well as the self-care capacities of each patient prior to discharge. Optimal regimens should be individualized for each patient.

Patients may require a significant dose adjustment after discharge from the hospital, which is why clear communication between the clinician dealing with the acute illness and the clinician who will follow the patient's diabetes care after discharge is so important.

Patients found to be newly hyperglycemic during times of illness may actually have undiagnosed diabetes. A glycohemoglobin test A1C can help discriminate between acute, stress-related hyperglycemia and preexistent diabetes.

At a minimum, these individuals should be retested as outpatients upon full recovery. Adequate patient education, discharge planning, and the important transition to the outpatient arena should be facilitated by the personnel dedicated to diabetes care at each institution.

SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. See "Society guideline links: Diabetes mellitus in adults" and "Society guideline links: Diabetes mellitus in children".

See 'Goals in the hospital setting' above. See 'Noncritically ill' above. More stringent goals may be appropriate for stable patients with previous good glycemic management, and more conservative targets should be set for older patients and those with severe comorbidities where the heightened risk of hypoglycemia may outweigh any potential benefit.

Frequent blood glucose monitoring is warranted to prevent serious hyperglycemia from being unrecognized. See 'Diet-treated patients' above. However, if blood glucose levels are poorly managed with the usual oral agents or if the patient is not eating, drug therapy should be discontinued and insulin initiated algorithm 2.

See 'Patients treated with oral agents or injectable GLPbased therapies' above. See 'Patients treated with insulin' above. For subcutaneous insulin, sliding scales should never be used as the sole insulin.

Optimally, basal insulin glargine, detemir, degludec, or neutral protamine hagedorn [NPH] should be combined with prandial and correction insulin typically, rapid-acting insulin algorithm 1 and algorithm 2.

See 'Patients with type 1 diabetes' above. Blood glucose should be measured frequently every one to two hours in patients receiving an insulin infusion. See 'Insulin infusion' above. Why UpToDate? Product Editorial Subscription Options Subscribe Sign in.

Learn how UpToDate can help you. Select the option that best describes you. View Topic. Font Size Small Normal Large. Management of diabetes mellitus in hospitalized patients. Formulary drug information for this topic. No drug references linked in this topic.

Find in topic Formulary Print Share. View in. Language Chinese English. Author: Silvio E Inzucchi, MD Section Editor: David M Nathan, MD Deputy Editor: Katya Rubinow, MD Contributor Disclosures.

All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Jan This topic last updated: Jan 04, Insulin delivery Basal-bolus or basal-nutritional insulin regimens — Although most patients will have type 2 diabetes, many will require at least temporary insulin therapy during inpatient admissions.

Comprehensive management of the hospitalized patient with diabetes. Endocrinologist ; Moss SE, Klein R, Klein BE. Risk factors for hospitalization in people with diabetes. Arch Intern Med ; Chaney MA, Nikolov MP, Blakeman BP, Bakhos M. Attempting to maintain normoglycemia during cardiopulmonary bypass with insulin may initiate postoperative hypoglycemia.

Anesth Analg ; Nasraway SA Jr. Sitting on the horns of a dilemma: avoiding severe hypoglycemia while practicing tight glycemic control. Crit Care Med ; Turchin A, Matheny ME, Shubina M, et al. Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward.

Diabetes Care ; Clement S, Braithwaite SS, Magee MF, et al. Management of diabetes and hyperglycemia in hospitals. Umpierrez GE, Isaacs SD, Bazargan N, et al.

Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab ; Pomposelli JJ, Baxter JK 3rd, Babineau TJ, et al.

Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. JPEN J Parenter Enteral Nutr ; Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline.

American Diabetes Association Professional Practice Committee. Diabetes Care in the Hospital: Standards of Care in Diabetes Diabetes Care ; S Hirsch IB, Paauw DS, Brunzell J.

Inpatient management of adults with diabetes. Jacober SJ, Sowers JR. An update on perioperative management of diabetes. Inzucchi SE. Clinical practice. Management of hyperglycemia in the hospital setting. N Engl J Med ; Spanakis EK, Urrutia A, Galindo RJ, et al.

Continuous Glucose Monitoring-Guided Insulin Administration in Hospitalized Patients With Diabetes: A Randomized Clinical Trial. Fortmann AL, Spierling Bagsic SR, Talavera L, et al. Glucose as the Fifth Vital Sign: A Randomized Controlled Trial of Continuous Glucose Monitoring in a Non-ICU Hospital Setting.

Torres Roldan VD, Urtecho M, Nayfeh T, et al. A Systematic Review Supporting the Endocrine Society Guidelines: Management of Diabetes and High Risk of Hypoglycemia. McCall AL, Lieb DC, Gianchandani R, et al. Management of Individuals With Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline.

Queale WS, Seidler AJ, Brancati FL. Glycemic control and sliding scale insulin use in medical inpatients with diabetes mellitus. Shetty S, Inzucchi SE, Goldberg PA, et al. Adapting to the new consensus guidelines for managing hyperglycemia during critical illness: the updated Yale insulin infusion protocol.

Endocr Pract ; Goldberg PA, Siegel MD, Sherwin RS, et al. Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit. Yamashita S, Ng E, Brommecker F, et al.

Implementation of the glucommander method of adjusting insulin infusions in critically ill patients. Can J Hosp Pharm ; John SM, Waters KL, Jivani K. Evaluating the Implementation of the EndoTool Glycemic Control Software System.

Diabetes Spectr ; Umpierrez GE, Gianchandani R, Smiley D, et al. Safety and efficacy of sitagliptin therapy for the inpatient management of general medicine and surgery patients with type 2 diabetes: a pilot, randomized, controlled study.

Vellanki P, Rasouli N, Baldwin D, et al. Glycaemic efficacy and safety of linagliptin compared to a basal-bolus insulin regimen in patients with type 2 diabetes undergoing non-cardiac surgery: A multicentre randomized clinical trial. Diabetes Obes Metab ; Umpierrez GE, Hor T, Smiley D, et al.

Comparison of inpatient insulin regimens with detemir plus aspart versus neutral protamine hagedorn plus regular in medical patients with type 2 diabetes. Umpierrez GE, Smiley D, Zisman A, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes RABBIT 2 trial.

Schoeffler JM, Rice DA, Gresham DG. Ann Pharmacother ; Umpierrez GE, Smiley D, Jacobs S, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery RABBIT 2 surgery. Umpierrez GE, Smiley D, Hermayer K, et al. Randomized study comparing a Basal-bolus with a basal plus correction insulin regimen for the hospital management of medical and surgical patients with type 2 diabetes: basal plus trial.

Ballani P, Tran MT, Navar MD, Davidson MB. Clinical experience with U regular insulin in obese, markedly insulin-resistant type 2 diabetic patients. htm Accessed on September 28, Bally L, Thabit H, Hartnell S, et al. Closed-Loop Insulin Delivery for Glycemic Control in Noncritical Care.

Wesorick D, O'Malley C, Rushakoff R, et al. Management of diabetes and hyperglycemia in the hospital: a practical guide to subcutaneous insulin use in the non-critically ill, adult patient. J Hosp Med ; Korytkowski MT, Salata RJ, Koerbel GL, et al. Insulin therapy and glycemic control in hospitalized patients with diabetes during enteral nutrition therapy: a randomized controlled clinical trial.

Levetan CS, Salas JR, Wilets IF, Zumoff B. Impact of endocrine and diabetes team consultation on hospital length of stay for patients with diabetes. Am J Med ; Koproski J, Pretto Z, Poretsky L. Effects of an intervention by a diabetes team in hospitalized patients with diabetes.

Smith SA, Poland GA. Use of influenza and pneumococcal vaccines in people with diabetes. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient.

It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances.

Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications.

This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient.

See "Patient education: Type 2 diabetes: Overview Beyond the Basics " and "Patient education: Glucose monitoring in diabetes Beyond the Basics " and "Patient education: Hypoglycemia low blood glucose in people with diabetes Beyond the Basics " and "Patient education: Exercise and medical care for people with type 2 diabetes Beyond the Basics " and "Patient education: Preventing complications from diabetes Beyond the Basics " and "Patient education: Type 2 diabetes and diet Beyond the Basics ".

Keeping blood sugar levels under control is one way to decrease the risk of complications related to type 2 diabetes, particularly microvascular complications. Chronically high blood sugar can injure the small blood vessels of the eyes, kidneys, and nerves and lead to serious issues including blindness, kidney failure, foot ulcers requiring amputation, and sexual dysfunction in men.

Microvascular complications usually occur after a person has had diabetes for many years, and they are related to elevated levels of blood sugar over time. However, in some cases eg, if a person has already had diabetes for a long time before they seek medical care , these complications may be present at the time of initial diagnosis.

The most common complication of type 2 diabetes is cardiovascular heart disease, also known as macrovascular disease "macro" means large, ie, affecting the large blood vessels. Heart disease increases a person's risk of heart attack and death.

There are many ways to lower the risk of heart disease, including lifestyle changes such as avoiding smoking, eating a healthy diet, exercising regularly, and maintaining a healthy weight and medications to control blood pressure and cholesterol, if needed.

Specific diabetes drugs also help reduce the risk of cardiovascular disease in people with or at high risk for cardiovascular disease.

See "Patient education: Preventing complications from diabetes Beyond the Basics ". Monitoring — Many people with type 2 diabetes need to check their blood sugar regularly.

This is especially important for people who use insulin or other medications that can lower blood sugar levels too much. That's because while high blood sugar hyper glycemia can lead to complications, having a blood sugar level that is too low hypo glycemia can also cause problems. See "Patient education: Glucose monitoring in diabetes Beyond the Basics ".

Overall blood sugar management is often measured by checking the level before the first meal of the day fasting. Your health care provider can work with you to determine what your goal should be. The frequency of testing and blood sugar goals can change over time, so it's important to see your health care provider regularly.

See 'How often to see your provider' below. Blood sugar control can also be measured with a blood test called A1C, also called HbA1c. The A1C blood test is an indicator of your average blood sugar level over the past two to three months. Knowing your average level can be useful as blood sugar levels can fluctuate throughout the day depending on your diet and activity level.

The A1C test involves having a blood sample taken either from a vein or through a finger prick in a doctor's office for testing. However, different people have different goals for their A1C level. For example, people who are older or have several other medical conditions might have a slightly higher goal.

Your health care provider will work with you to understand your A1C goal. The A1C measures the amount of blood sugar that is stuck to hemoglobin, a molecule in red blood cells.

Sometimes, the A1C cannot accurately measure average blood sugar; this can be due to conditions that affect red blood cells or normal variations in how long the red blood cells last in the body.

If your health care provider suspects that your A1C results are inaccurate, they may use other methods to measure your blood sugar level.

How often to see your provider — Most people with type 2 diabetes meet with their health care provider every three to four months. At these visits, you will discuss your blood sugar and other care goals and how you are managing your diabetes, including your medications.

This allows you and your provider to work together to fine-tune your care plan and keep you as healthy as possible. STARTING INSULIN. Most people who are newly diagnosed with type 2 diabetes begin initial treatment with a combination of diet, exercise, and an oral pill or tablet medication.

Over time, some people will need to add insulin or another injectable medication because their blood sugar levels are not well managed with oral medication. In some cases, insulin or another injectable medication is recommended first, as initial treatment.

Your health care provider will talk to you about your options and goals, and work with you to make a treatment plan. Types of insulin — There are several types of insulin. These types are classified according to how quickly the insulin begins to work and how long it remains active in the body:.

One form of inhaled insulin brand name: Afrezza is available in the United States. Inhaled insulin has not been shown to lower A1C levels to the usual target level of less than 7 percent in most studies. In addition, lung function testing is required before starting it and periodically during therapy.

For these reasons, inhaled insulin has not been used widely. Initial insulin dose — When insulin is started for type 2 diabetes, health care providers usually recommend "basal" insulin; this means taking intermediate-acting or long-acting forms of insulin to keep blood sugar controlled overnight and throughout the day.

Basal insulin is usually given once per day, either in the morning or at bedtime. Basal insulin is usually started at a low dose 10 to 20 units and then increased gradually to determine the right dose for an individual.

Using a combination of treatments ie, an oral medication plus insulin generally lowers the dose of insulin compared with taking insulin only.

Since insulin can cause weight gain, combination therapy may reduce the risk of weight gain. Your health care provider will work with you to monitor your body's response and adjust the dose over time. Adjusting insulin dose over time — To determine how and when to adjust your once-daily insulin dose, you will need to check your blood sugar levels.

This is usually done with a home glucose meter in the morning before eating. If the value is consistently higher than your fasting blood sugar goal, and you do not have episodes of low blood sugar especially overnight , your provider may recommend increasing your insulin dose.

If the basal once-daily insulin regimen is still not adequately controlling your blood sugar levels, your health care provider might recommend giving two or more insulin injections each day.

Being diagnosed with a new medical problem or starting a new medication can also change the body's needs for insulin, sometimes requiring a change in diabetes treatment. For example, when a person with type 2 diabetes takes steroids eg, prednisone for an asthma attack or other reasons, the blood sugar levels increase.

This usually requires temporarily increasing the dose of insulin. Type 2 diabetes typically progresses over time, causing the body to produce less insulin. Some people will need a more complex insulin regimen.

In this situation, a pre-meal prandial dose of rapid-acting or short-acting insulin is added to the basal insulin. As a first step, prandial insulin may be started as a single injection before the largest meal of the day, but your health care provider might suggest another approach.

The dose of short-acting or rapid-acting insulin is adjusted immediately prior to a meal; the dose needed depends on many different factors, including your current and goal blood sugar levels, the carbohydrate content of the meal, and your activity level.

People with type 2 diabetes are occasionally treated with "intensive" insulin regimens. Intensive insulin treatment requires multiple injections of insulin per day or the use of an insulin pump. It also requires measuring blood sugar levels several times a day, with adjustment of pre-meal insulin dosing based on the size and carbohydrate content of the meal.

This approach is more commonly used in people with type 1 diabetes, and it is discussed in greater detail in a separate topic review. See "Patient education: Type 1 diabetes: Insulin treatment Beyond the Basics ", section on 'Intensive insulin treatment'. INJECTING INSULIN.

Insulin cannot be taken in pill form. It is usually injected into the layer of fat under the skin called "subcutaneous" injection with a device called a "pen injector" or a needle and syringe.

Insulin can be injected into different areas of the body figure 1. You will need to learn how to use an insulin pen injector or, if you use a needle and syringe, draw up and inject your insulin. You may also want to have your partner or a family member learn how to give insulin shots.

The site and the insulin dose determine how quickly the insulin is absorbed. See 'Site of injection' below. Insulin pen injectors — Insulin pen injectors may be more convenient to carry and use, particularly when you are away from home. Most are approximately the size of a large writing pen and contain a cartridge that contains the insulin, a dial to set the dose, and a button to deliver the injection figure 2.

A new needle must be attached to the pen prior to each injection. The needles are sold separately from the pens. Insulin pen cartridges should never be shared, even if the needle is changed. The injection technique is similar to using a needle and syringe.

See 'Injection technique' below. Pens are especially useful for accurately injecting very small doses of insulin and may be easier to use for people with vision or dexterity problems. Pens are more expensive than traditional syringes and needles.

A number of different insulin pens are available; each comes with specific instructions for use, and video tutorials are available online. Needle and syringe — Some people use a needle and syringe rather than a pen injector to give themselves insulin.

This involves drawing up insulin from a bottle using the syringe, then injecting it with the needle. Drawing up insulin — There are many different types of syringes and needles, so it's best to get specific instructions for drawing up insulin from your health care provider.

The basic steps are listed in the table table 2. See 'Insulin pen injectors' above. Before drawing up insulin, it is important to know the dose and type of insulin needed; if you use more than one type of insulin, you will need to calculate the total dose needed your health care provider will show you how to do this.

Some people, including children and those with vision problems, may need assistance. Magnification and other assistive devices are available. If you have difficulty drawing up your insulin, let your health care provider know, as there are ways to help with this.

One type of insulin, called U regular insulin, might come in a pen or a vial. When it comes in a vial, it requires a special U syringe; this syringe makes it easier to measure the right dose. If you use this type of insulin, your health care provider can show you how to use the U syringe.

It's very important to use this specially marked syringe only for U insulin. Using a U syringe with other insulins can cause a dangerous insulin overdose. Because it can be confusing to figure out how to accurately measure the correct dose, U insulin and other concentrated insulins U lispro or degludec should be prescribed in an insulin pen device under most circumstances.

Injection angle — Insulin is usually injected under the skin figure 3. It is important to use the correct injection angle since injecting too deeply could deliver insulin to the muscle, where it is absorbed too quickly. On the other hand, injections that are too shallow are more painful and not absorbed well.

The best angle for insulin injection depends on your body type, injection site, and length of the needle used. Your health care provider can help you figure out what length needle to use and the angle at which to inject your insulin. Injection technique — These are the basic steps for injecting insulin:.

You do not need to clean the skin with alcohol unless your skin is dirty. Keep the skin pinched to avoid injecting insulin into the muscle. Hold the syringe and needle in place for 5 seconds for syringes and 10 seconds for insulin pens. If you see blood or clear fluid insulin at the injection site, apply pressure to the area for a few seconds.

Do not rub the skin, as this can cause the insulin to be absorbed too quickly. Each needle and syringe should be used once and then thrown away; needles become dull quickly, potentially increasing the pain of injection. Needles and syringes should never be shared.

Used needles and syringes should not be included with regular household trash but should instead be placed in a puncture-proof container eg, a hard laundry detergent bottle or a sharps container, which is available from most pharmacies or hospital supply stores.

FACTORS AFFECTING INSULIN ACTION. Dose of insulin injected — The dose of insulin injected affects the rate at which the body absorbs it. Larger doses of insulin may be absorbed more slowly than smaller doses. Site of injection — It is very important to rotate injection sites ie, avoid using the same site each time to minimize tissue irritation or damage.

When changing sites, it is important to keep in mind that insulin is absorbed at different rates in different areas of the body. Insulin is absorbed fastest from the abdominal area, slowest from the leg and buttock, and at an intermediate rate from the arm.

This may vary with the amount of fat present; areas with more fat under the skin absorb insulin more slowly figure 1. It is reasonable to use the same general area for injections given at the same time of the day.

Sometimes abdominal injections, which are absorbed more quickly, are preferred before meals. Injection into the thigh or buttock may be best for the evening dose because the insulin will be absorbed more slowly during the night.

Mayo Clinic offers appointments in Diahetics, Florida and Sustainable stamina enhancers and at Manayement Clinic Health Blood sugar management for diabetics locations. Fod management takes awareness. Know what fod your blood sugar level rise and fall — and how to control these day-to-day factors. When you have diabetes, it's important to keep your blood sugar levels within the range recommended by your healthcare professional. But many things can make your blood sugar levels change, sometimes quickly. Your care team manageement call Body composition enhancers "diabetes control. The blood sugar level fpr the amount of glucose in Blood sugar management for diabetics blood. Glucose is a sugar that comes from the foods we eat, and it's also formed and stored inside the body. Keeping blood sugars in the healthy range will help your child have more energy and grow well. It will also prevent health problems in the future.