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Buying syringes at PlanetRx
PlanetRx will soon be offering a full line of syringes and auto injectors for your diabetic care needs. Please check back with us soon.
You're not really stuck with the stick
For diabetics, any new way to ease the daily task of injecting insulin is welcome. Disposable syringes are available prefilled for convenience, and designed for accuracy and ease of use. If you're needle-shy, auto injectors can shoot insulin into your subcutaneous (SC) tissues with high-pressure liquid. At the next level are pumps that release insulin into your SC tissues in small amounts during the day and come close to mimicking natural pancreatic secretions. Pumps are expensive, about $5,000, and not all insurance policies cover them. But if you have trouble maintaining insulin levels, they're the high-tech way to regain a relatively normal lifestyle.
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Using Needles and Syringes
If your diabetes treatment requires that you inject yourself with insulin, you will need to purchase syringes and get comfortable with using them on yourself or your patient. While it can be an unpleasant task, it is an important part of managing your diabetes effectively.
- Syringes are available over-the-counter with proper use from most pharmacies.
- Make sure you buy syringes that are appropriate for measuring out all your dosages.
- If you have limited hand mobility, there are several injection aid devices on the market that help you guide the syringe and stabilize the vial while drawing up insulin.
- Those with vision impairment should inquire about syringes with extra-large type, magnifiers, raised type, Braille, or pre-filled.
- Syringes prefilled with insulin are available.
- Check with your pharmacist to see if syringes are cheaper when bought in bulk quantities.
- Some syringes come with caps to cover the needle when it is not in use.
- Used syringes are considered a biohazard! Dispose of them properly in hard-sided containers.
Use the Right Syringe for Accuracy
- Syringes vary in unit calibration and total volume.
- Because insulin is delivered in units (U), not milliliters (mL), you will need to purchase syringes that are calibrated in units.
- For the most accurate measurement of insulin, use a syringe calibrated in the same units as your insulin. For example, use U-100 syringes with U-100 preparation insulin.
- Use low-dose syringes calibrated in single units to measure out low-dose amounts.
- Syringes with colored plungers can be easier to read than syringes with clear plungers.
Glass vs. Plastic Syringes
- Glass syringes are made to be used over and over again, while plastic syringes are intended to be disposed of after each use.
- Reuse of plastic syringes is a common practice. While reuse of plastic syringes does not show an increased instance of infection or contamination, doctors do not generally recommend it.
- Plastic syringes are generally more accurate than glass ones.
- Contrary to what you might expect, glass syringes are less expensive than plastic ones.
- Plastic syringes are capable of bearing smaller-gauge needles than glass syringes. The smaller the gauge of the needle, the more comfortable penetration will be.
- Plastic syringe needles are also coated with silicone to ease penetration.
If You Choose to Reuse
If you are thinking about reusing plastic syringes, remember that it is not recommended. That said, you should know that studies indicate that syringes have been reused for at least three days without complications. So if you are reusing your syringes and are not experiencing any problems, there is no need to stop reusing. However, if you are prone to infection or have difficulty in recapping needles, reuse is not recommended. If you are considering needle reuse, talk it over with your physician. Never share used syringes.
Reused syringes must be kept from becoming contaminated. Keep a close watch to ensure that your syringes do not touch anything that might cause contamination, and keep them out of easily accessible areas. Some suggestions that may be helpful are:- Store used syringes in the refrigerator to discourage bacterial growth.
- Wrap the barrel in transparent tape to keep the calibrations from rubbing off.
- Clean needles with alcohol before and after use to kill and reduce bacteria. (But this may also remove the silicone coating on the needles, which is there to make penetration less painful.)
What If You Have a Needle Phobia?
For individuals who find it difficult or unpleasant to inject themselves with syringes, there are a number of injection aids on the market. Injection aids vary in the way in which they aid injection, price, convenience, and maintenance. Some aids merely hide the needle from view to alleviate anxiety about injection, while others do not use needles at all. Injection aids, when used properly, are no more or less accurate than the syringe method. However, because more complex mechanisms are involved than in the syringe method, there is a greater chance for mechanical and human error.
Here are some injection aids that are available:- Drawing aids help you draw insulin by positioning the syringe and insulin vial.
- Magnifiers can make the dosing labels on syringes easier to see.
- Dose gauges help you calibrate the correct dose to draw.
- Auto injectors can help with self-injection fears.
- Catheters can be inserted into the abdomen, allowing insulin dosing without injection.
- And there are many other products being developed and tested.
Because using injection aids improperly can lead to dosing errors, confirm with your doctor that injection aids are right for you.
- Training is required for injection aids -- improper usage can result in insufficient or excessive delivery of insulin.
- Injection aids can be costly and/or time-consuming.
- Some injection aids are not recommended for the elderly, children, and thin-skinned individuals.
An External Insulin Pump Can Be an Alternative
- External insulin pumps deliver not only large amounts of insulin (or boluses), but also slow, steady amounts for times when the wearer is not eating. This gives you greater control and flexibility, but it requires greater responsibility and knowledge.
- External insulin pumps are not for everyone, and they are by no means an easy way out of insulin therapy. They are suggested for individuals who have proven that they are extremely conscientious about managing their diabetes.
- External insulin pumps are worn outside the body and are connected to the injection site, usually the abdomen, by tubing. For this reason, patients should be aware that using an insulin pump requires that they be comfortable with displaying a public sign of their diabetes.
- For now, external insulin pumps are "open loop," meaning that they cannot determine how much insulin you need. You must still measure your own blood sugar and then tell the pump how much insulin to deliver.
- The use of an external insulin pump requires that you learn the approximate amount of insulin required for everything you eat. This requires practice and some calculations. You must be mature and responsible enough to handle this on your own.
- Good candidates for external insulin pumps include:
-Pregnant women
-Individuals with brittle (difficult to control) diabetes
-Responsible patients with Type I diabetes
-Patients who have complications that make the syringe method difficult or impossible - Be sure that there are doctors and nurses in your vicinity who are familiar with this relatively new technology.
Safety Is Built into Pumps
- The pumps are designed so that excessive delivery of insulin is not possible.
- An alarm sounds in the event of a low battery, a disconnected tube, blockage in the tubing, or low insulin reserves.
Pumps Have Drawbacks
- Because the insertion site is the same for several days, you have an increased chance of developing skin infections when using an insulin pump.
- Also, because regular insulin (fast-acting insulin) is used and delivered in slow trickles, if at any time the pump ceases working, you may be at risk for developing keotacidosis in a matter of hours.
- With the pump, the signs of hypoglycemia may be different from what you "normally" experience.
Pumps Can Be Costly
- External insulin pumps can cost upwards of $4,000, not including supplies.
- Check with your insurance company to see if they will cover part or all of the cost of your pump. Don't take the first "no" as the final answer! Keep writing letters, keep negotiating, and get people such as your doctor or employer to write on your behalf.
- Because insulin pumps are such a huge financial investment, see if you can "test drive" one before making a commitment.
Never Share Equipment
- Never share diabetic equipment that penetrates your skin or comes into contact with bodily fluids such as blood or saliva (e.g. syringes, auto injectors, catheters, glucose monitors, lancing devices. This reduces the chance of transmitting and/or contracting any infectious disease such as HIV, hepatitis, or syphilis.
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INGREDIENTS
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What Are Syringes For?
- Syringes are used to draw insulin out of a vial, penetrate the skin, and deliver insulin into the body.
- Syringes come in the reusable (glass) and disposable (plastic) variety.
Mechanics of the Syringe
- A syringe consists of three parts.
- The needle is hollow and is capable of drawing in and releasing fluid.
- The barrel is the calibrated body of the needle that holds the fluid.
- The plunger aids in pulling fluid into and pushing fluid out of the barrel.
What's an Injection Aid For?
- Injection aids are designed to make the injection of insulin more comfortable for patients.
How Do Injection Aids Work?
- Automatic injectors can come in the form of insulin pens that can deliver pre-set doses with a simple press of a button. Some automatic injectors slip over the syringe like a jacket and, using a spring, guide the needle into the skin.
- Infusers are catheters that stay under the skin, requiring only one injection until the catheter must be replaced. When the time comes to inject insulin, the syringe is inserted in the portion of the catheter that is exposed, rather than under the skin. The catheter seals itself and does not remain open.
- Jet injectors create a thin stream of insulin and direct it at the skin with so much force that the insulin enters the skin and gets into the tissue. While it sounds as uncomfortable as a syringe, users report they hardly feel anything at all.
What's an Insulin Pump For?
- Insulin pumps offer diabetic individuals requiring insulin therapy greater flexibility and control over their diabetes management.
Mechanics of the Insulin Pump
- The pump itself is about the size of a pager and is worn outside the clothing.
- Inside the pump is a vial filled with insulin.
- The pump releases insulin from the vial at the appointed times.
- Insulin leaves the pump in a thin catheter and enters the body.
- Important: this is an open-loop machine. The external insulin pump does not know how much insulin you need and in no way takes the place of self blood glucose monitoring.
- External insulin pumps deliver a steady, slow stream of insulin for when the wearer is not eating.
- It is up to the wearer to determine when to deliver the large doses of insulin required to manage the intake of a meal.
Preparing Yourself for an Injection With a Syringe
- Inspect your insulin. Are there clumps? If so, use another vial.
- If you are using mixed preparations of insulin or intermediate acting insulin, you must first "mix" the preparation. But this does not mean you should shake it! Bubbles in the insulin can get into the syringe and produce inaccurate dosing and cause discomfort if injected.
- Roll the vial between the palms of your hands. You may use the same method to warm up recently refrigerated insulin, as cold insulin can be uncomfortable to inject.
- Wash your hands with soap and water.
- Because all insulin (except regular insulin) is in suspension (meaning not completely or evenly dissolved in the fluid), you must agitate the bottle gently. Failing to agitate the bottle before use can result in dosages of uneven strength. Wait until foam or bubbles subside after agitation.
- Clean the rubber stopper on the vial with alcohol.
- Touching only the barrel and the plunger, take the clean syringe and measure out an amount of air into the barrel that is equivalent to the volume of your dosage. Why? You want to prevent creating a vacuum in the vial, so by injecting an amount of air into the vial that is equal to the amount of fluid you will be drawing out, you can prevent the vacuum effect.
- Inject the air into the vial. Turn the vial upside down until the entire needle is covered by fluid.
- Draw out the correct dosage. Remove the needle from the vial.
- Tap the barrel of the syringe to loosen any air bubbles that might be clinging to the side of the barrel and expel the air bubbles.
Injecting Insulin
- With one hand, pinch a fold of skin at the injection site. Why? You want to pull the skin away from the muscle to avoid injecting the insulin into the muscle. Muscle absorbs insulin faster than tissue and you may become hypoglycemic.
- There are a number of suggestions when it comes to deciding at which angle to insert the needle. Some suggest holding the needle so that it stands perpendicular to your skin and then inserting. Others suggest pushing the needle at anywhere from a 45-degree angle to a 90-degree angle to your skin. Obese patients require an angle closer to 90 degrees, and thin patients require an angle closer to 45 degrees. Poke around --literally! Experiment and choose the position that is most comfortable for you.
- Before injecting the contents of the plunger, pull the plunger back slightly to make sure you haven't hit a blood vessel. If blood appears in the syringe, remove the needle and try another location. If not, proceed by depressing the plunger to complete the injection.
- When finished, remove the needle quickly.
- To avoid bruising, immediately apply pressure to the insertion site.
- Recap the needle carefully to avoid accidental sticking.
- Record the injection site so that you can effectively alternate your injection sites to avoid excessive soreness and scarring.
- Remember: Different injection sites produce different times to onset of effectivity. Consult the Insulin section for a brief description of the different sites.
Rotate Injection Sites
- Injection sites for syringes should be rotated to avoid insulin hypertrophy and lipoatrophy, which are side effects of injecting insulin.
- Wait AT LEAST 14 days before using the same injection site.
- Injection sites should have a layer of fat underneath that you can pinch. You should consult your healthcare provider. They have charts showing injection sites, and can help you determine which sites to use and when. Some typical injection sites are:
-The abdomen, except a one-inch radius around the navel. This circle of skin may produce erratic insulin absorption. The abdomen yields the quickest and most consistent absorption of insulin.
-The upper thighs, outer thighs, and back of the upper arms. Insulin is absorbed slower from these sites than from the abdomen.
-The buttocks are also a possible site for injection. Insulin is absorbed the slowest from this site. - Quarter-sized areas of skin make good injection sites, and injection sites should be approximately one inch apart.
- Avoid injecting near moles, scars, or areas that are bony (lack subcutaneous fat).
External Pumps
- Read the instructions provided by the manufacturer and obtain training from your doctor or pharmacist.
- Proper usage is essential, as insufficient or excessive dosage can occur.
- NEVER purchase or use an external insulin pump without the guidance of your doctor.
- Obtain proper training, and do not stop training until you are completely comfortable.
- The first few weeks of using a pump can be difficult. For this time, make sure you can always contact a doctor.
- Always have enough supplies such as syringes and insulin, so that if your external insulin pump malfunctions, you have some means of delivering the required dosage of insulin.
- Always consult your healthcare provider on how to properly use an insulin pump.
- Each person's insulin schedule will vary. Consult your doctor before making any changes to your machine.
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Insulin Hypertrophy & Lipoatrophy
Injecting insulin repeatedly into your subcutaneous tissues can cause changes at these sites. Minor damage to blood vessels can cause bruising, which will heal and is not life-threatening. If you notice blood at the site of injection, apply pressure to the site to reduce the likelihood of bruising.
Of greater concern is insulin hypertrophy of adipose tissue and lipaotrophy. These two effects are also not life-threatening but can affect insulin absorption. Both of these effects may be avoided by rotating injection sites.
Insulin Hypertrophy- Insulin hypertrophy (also known as lipohypertrophy) results in adipose tissue enlargement near the site of insulin injection. This can result in fatty, lumpy areas.
- The cause is not known but is thought to be a consequence of insulin increasing glucose absorption and fat production.
- The fatty deposits are harmless, but you may find them cosmetically unacceptable.
- If you inject insulin into a site that has hypertrophied, avoid injecting into fatty lumps. Insulin may not be absorbed effectively through them.
- Hypertrophy usually disappears or diminishes when the injection site is rotated.
Lipoatrophy- Lipoatrophy causes the fat under your skin to disappear, leaving a slight, sometimes fibrous, depression. These effects can be thought of as the opposite of lipohypertrophy.
- The cause of lipoatrophy is unknown, but it is thought to be an immunological reaction to insulin that inadvertently damages the fatty tissue near the insulin. Another theory suggests that lipoatrophy is the result of damage from repeated injections at a site.
- To reduce the chance of an immunological reaction, you can switch to human insulin. Human insulin is less likely to produce an immune response than beef- or pork-derived insulin.
- As in lipohypertrophy, depressions from lipoatrophy are cosmetic and not life-threatening.
- To avoid lipoatrophy, rotation of injection sites and human insulin are recommended.
- To reverse lipoatrophy, human insulin is often injected near the border of the depression. The rationale is that insulin's fat deposition effect will help fill the depression with adipose tissue. This process can take months to complete.
- Never inject insulin into lipoatrophied depressions, because the absorption from these sites is unpredictable.
Use Caution When Disposing of Syringes
- Important: Dispose of used syringes properly! They are considered a biohazard.
- Each state and country has specific laws regarding the disposal of biohazardous waste. Educate yourself about the law and follow closely.
- Save someone from unnecessary worry and injury! Dispose of your syringes in hard-sided containers that cannot be penetrated by syringes.
- Always keep syringes out of reach of small children.
Syringe Safety Precautions
- NEVER share syringes with anyone.
- Used and unused syringes are particularly attractive to IV drug users. Save IV drug users from unnecessary contamination, infection, and harm by storing and disposing of your syringes discreetly and properly.
- There are devices that safely clip the tips of needles while containing the tip to assure that it does not fly off and get lost. Unless you have one of these, do not clip your needles. You may lose the clipped piece and it could get stepped on and embedded in someone's foot.
- If you are reusing a syringe, store it in a clean, dry place out of the reach of children.
- Using alcohol to clean a plastic syringe will remove the silicone coating from the needle, which is there to ease penetration.
- The more you reuse a syringe, the duller the needle becomes, and the more painful insertion can be.
Auto Injectors Require Careful Use
- Infusers require a certain amount of maintenance of the injection site. You must be prepared to clean the site carefully to avoid infection.
- The risk of infection with an infuser is greater than with a syringe.
- Jet injectors must be held firmly against the skin or complete dosage may not occur.
- Jet injectors should be used with caution by individuals with little body fat. Jet injectors may force insulin into the muscles.
- Jet injectors may shorten the time to onset of effectivity. Patients should adjust their doses accordingly.
- Proper usage is essential, as insufficient or excessive dosage can occur.
Using External Insulin Pumps Requires Extra Training and Advice
- Never purchase or use an external insulin pump without the guidance of your doctor.
- Obtain proper training from your doctor and make sure you are completely comfortable using the device. Getting acclimated to the pump can take up to six months!
- The first few weeks you use the pump can be difficult. During this time, make sure you can always contact a doctor.
- Always have enough back-up supplies like syringes and insulin, so if your external insulin pump malfunctions you will have an alternate means of delivering the required dosage of insulin.
- Make sure that you have food readily accessible before delivering a large dose of insulin through the pump.
- If you are experiencing high glucose levels while wearing a pump, consider the following possibilities:
-Is your insertion site near a mole or scar?
-Is the tissue in that area excessively scarred?
-Is the insulin near empty?
-Did the needle come out?
-Is the line clogged?
-Is the insulin expired or compromised in some way?
-Check the battery. - You should understand that the use of pumps puts you at risk for ketoacidosis.
Hypoglycemia Happens
Hypoglycemia, low blood sugar, may occur if you have diabetes. Don't immediately blame yourself for episodes of hypoglycemia; in managing your diabetes, you are attempting to control a very complex, intricate, and inconsistent system. Hypoglycemic episodes can be avoided with proper diet (not skipping meals), exercise (not in excess), and dose of prescription medication. If you are experiencing hypoglycemic episodes, contact your healthcare provider to see how you can avoid hypoglycemia.
Generally, if your blood sugar drops below 50 to 55 mg/dl, you are considered hypoglycemic. Before you decide to treat your hypoglycemia with glucose tabs, gels, or other sugars, take (if possible) a blood glucose test to determine how much sugar you need. Symptoms will vary from person to person, but here are some hypoglycemia warning signs to watch out for:
- Rapid heartbeat
- Excessive sweating
- Muscle tremors
- Anxiety
- Hunger that can be extreme
- Irritability
- Vertigo
- Headache
- Blurred vision
- Confusion
- Convulsions in extreme cases.
- Unconsciousness in extreme cases
- Lethargy
- Fatigue
Hypoglycemia Unawareness
It is possible to have hypoglycemia and not experience any of the early warning symptoms. You may experience only the mental symptoms, and none of the physical symptoms. - Hypoglycemia unawareness was originally thought to be caused by nerve damage from living with diabetes for many years. This causes an absence of epinephrine release in response to low glucose levels.
- It is now thought that hypoglycemia unawareness may be caused by frequent episodes of low blood glucose, without pre-existing nerve damage. Episodes of hypoglycemia seem to lower the glucose levels at which epinephrine release, causing hypoglycemia without any of the physical symptoms.
- Hypoglycemia unawareness tends to affect people who control their glucose levels stringently. It also tends to affect pregnant women.
- An interesting comparison occurs in people who do control their blood sugars poorly. These people experience physical symptoms of hypoglycemia at much higher blood glucose levels than the average diabetic person.
If you have hypoglycemia unawareness, you need to consult your healthcare provider. Together you can develop a treatment regimen to ensure that you have adequate blood glucose levels and avoid situations where you might have low blood glucose. Keeping blood sugars at adequate levels to avoid hypoglycemia for days to weeks has been shown to restore sensitivity to hypoglycemia.How To Treat Hypoglycemia
- Get carbohydrates, "quick sugar", immediately. Carbohydrates can come from glucose tablets, non-diet soda, hard candy -- anything rich in sugar.
- Do not use carbohydrate sources that are also high in fat such as ice cream, chocolate, or cake. The excess fat can inhibit the absorption of carbohydrates.
- Keep your convenient glucose sources in your purse, pocket, car, or any other place that is quick and easy to access.
- Treat hypoglycemia correctly. Do not overeat carbohydrate sources or eat too little carbohydates.
- You should consume about 10 to 15 grams of carbohydates. Look at the nutritional labeling of the products you buy to determine how much you should consume to get 10 to 15 grams of carbohydrates. Do this ahead of time, not when you are experiencing hypoglycemia, because you might be tired and not thinking clearly.
- Below are some food equivalents for 10 to 15 grams of sugar:
6 large jellybeans (not the tiny gourmet kind)
4 to 7 LifeSavers
2 tablespoons of raisins
2 teaspoons of table sugar or honey
6 to 8 ounces of skim milk
Half a can of soda (not diet)
Note: "Quick sugar" provides only temporary restoration of blood sugar. After "quick sugar", you should eat a small snack such as crackers or 1/2 a sandwich to help maintain blood sugar. - Remember that it can take up to 20 minutes before carbohydates are efficiently absorbed into your bloodstream. If after 30 minutes you still feel symptoms of hypoglycemia, take another 10 to 15 grams of carbohydrate. Repeat this process until your symptoms are gone.
- If after two attempts of consuming sugar your symptoms have not disappeared, seek medical attention.
- It may be difficult but you must resist the temptation to eat more carbohydrates. Overeating can lead to hyperglycemia.
Educate Others
- Please educate your friends, family, and co-workers about what to do if you become unconscious.
- If you do become unconscious or so debilitated that you cannot ingest glucose tabs or food, you need glucagon, an injected drug that counteracts hypoglycemia.
- Instruct friends, family, and co-workers to take you to the hospital and/or call for an ambulance. Remind them that these are life-and-death situations.
- If you cannot receive medical attention immediately (in the case of a long ride to the hospital or a wait for an ambulance), instruct friends, family, and co-workers to place some glucose gel or cake frosting between your cheek and gums and to massage the outside of the cheek to help the gel or frosting dissolve.
- Make sure friends, family, and co-workers do not attempt to force sugar or food down your throat! You can choke!
- ALWAYS, no matter how well you manage your diabetes, carry glucose tabs, gels, or their food equivalent with you at all times and let those who are around you know exactly where they can find them.
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Websites, Organizations & Manufacturers
Sources & Further Reading
Books
- 1. American Diabetes Assocation. American Diabetes Association: Complete Guide to Diabetes. New York: Bantam Books 1996.
- 2. American Pharmaceutical Association. Handbook of Nonprescription Drugs. 11th ed. Washington., D.C.: American Pharmaceutical Assocation 1996.
- 3. Fauci, Anthony S. et al. Eds. Harrison's Principles of Internal Medicine, 14th ed. New York: MacGraw Hill 1998.
- 4. Saudek, Christopher D. et al. (Baltimore: JHU Press, 1997.The Johns Hopkins Guide to Diabetes for Today and Tomorrow. Baltimore: JHU Press 1997.
Find more books on health and wellness at  barnesandnoble.com.
Articles
- 1. American Diabetes Association."Buyer's guide to diabetes products '98.(Buyers Guide).". Diabetes Forecast; Vol. 52 10/1/1997.
- 2. Knight, Joseph."Inserting an insulin catheter: paving the way for multiple injections.". Nursing; Vol. 28 2/1/1998.
- 3. American Diabetes Association."Buyer's guide to diabetes products '98.(Buyers Guide).". Diabetes Forecast; Vol. 52 10/1/1997.
- 4. McCarren, Marie."Prepare to pump. (Insulin pump users discuss pros and cons).". Diabetes Forecast; Vol. 48 9/1/1995.
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