Diabetes Self-Management Education

What Is It?

Everyone's body naturally produces insulin from the pancreas to help control the amount of sugar floating around in the blood.

Who Should Take Insulin?

• All people with Type 1 diabetes  
  • Body no longer makes insulin
• People with Type 2 diabetes who have blood sugar levels that are too high and cannot be lowered enough by
  • Taking a pill or pills for diabetes
  • Exercising and staying active
  • Eating healthy foods and drinking healthy drinks

Where Should I Keep My Insulin?

In the refrigerator. Sit the insulin out of the refrigerator about 15 minutes before you take it to allow it to warm up. Cold insulin may burn or sting when a shot is given.

How Long Can I Use the Same Vial/Pen? 

How Does Insulin Work?

• Causing muscles and fat to “soak up” sugar from the blood 
• Not allowing the liver to make too much sugar 
• Preventing the breakdown of fat cells 
• Causing the body to make more protein (muscle)

Side Effects

It may cause your blood sugar to drop too low and you may feel:

• Dizzy 
• Sweaty 
• Shaky 
• Your heart may beat faster than normal

It may cause you to gain weight.

It may cause you to feel tired or to have a headache.

It may cause you to have a rash or feel itchy, especially around the area that you inject the needle.

Rapid-acting Insulin

HUMALOG (INSULIN LISPRO) / NOVOLOG (INSULIN ASPART) / APIDRA (GLULISINE)

• Starts working in 10 to 15 minutes
• Works best in one to two hours
• Lasts for three to five hours
• This insulin is clear
• Usually taken about 15 minutes before breakfast, lunch, and dinner
• This type of insulin helps to keep your blood sugar from getting too high after eating a meal or a snack 

Things to Remember

• Usually three injections every day - Not the case for ALL patients 
• Taken just before meals 
• Most likely to cause low blood sugar if you skip a meal or eat less at a meal

Short-acting Insulin

ALSO CALLED REGULAR INSULIN / NOVOLIN R / HUMULIN

• Starts working in 30 to 60 minutes 
• Works best in two to four hours  
• Lasts for four to eight hours 
• This insulin is clear 
• Very similar to rapid-acting insulin only lasts longer 
• Usually given about 30 minutes before breakfast, lunch, and dinner
• This type of insulin helps to keep your blood sugar from getting too high after eating a meal or a snack 

Things to Remember

• Usually three injections every day - Not the case for ALL patients 
• Taken just before meals
• Most likely to cause low blood sugar if you skip a meal or eat less at a meal 

Intermediate-acting Insulin

ALSO CALLED NPH INSULIN / HUMULIN N / NOVOLIN N

• Starts working in one to three hours
• Works best in four to 10 hours
• Lasts for 10 to 18 hours
• This insulin is cloudy
• Usually taken twice a day along with a rapid or short acting insulin
• Used to control blood sugar throughout the day and night, not just after you eat 

Things to Remember

• Usually two injections every day - Not the case for ALL patients
• Usually taken along with meals, but doesn’t have to be
• Less likely to get low blood sugar than rapid-acting or short-acting insulin, but still may happen if you skip meals, eat less at meals, or are more active one day
• Looks “cloudy” 

Long-acting Insulin

ALSO CALLED BASAL INSULIN

• This insulin is clear
• Usually taken once a day before breakfast or at bedtime
• This type works to control your blood sugar throughout the day and night

Things to Remember

• Usually one injection per day with Lantus, Toujeo, and Tresiba
• May be more in some patients 
• Tresiba: must be at least eight hours between consecutive injections
• Usually two injections per day with Levemir
• May be less in some patients
• Usually taken at bedtime if 1 injection per day, but may be taken in the morning
• Least likely to cause a drop in blood sugar but can still cause it to drop too low, especially if you skip meals, eat less at meals, or are a lot more active one day 
• Should not be mixed with other insulin

Pre-mixed Insulin

• Two different types of insulin that are already mixed together so you can take them both at the same time 
• This insulin is always cloudy

Things to Remember

• May decrease number of injections every day
• Usually only have one type/bottle of insulin rather than having several you have to mix yourself
• Do not have to draw two different insulins into one syringe - it’s already mixed
• It always looks “cloudy” 

Mixing Insulin

• What insulins can be mixed together in the same syringe?
  • NPH can be mixed with Humalog, Novolog, and Regular (R) insulin
  • Long-acting insulins (Lantus, Toujeo, Levemir, Tresiba) and Apidra (short acting) CANNOT be mixed with any other insulin
• If you are mixing “clear” and “cloudy” insulin into the same syringe the CLEAR insulin should be drawn- up FIRST, then the cloudy MIXING INSULIN

Insulin Injection - Where?

• Stomach (best)
• Use these three only if you can avoid injecting in a muscle 
  •  Butt
  •  Upper arm
  • Upper outer thigh

How to Inject Insulin

• Wash hands with warm water and soap
• Clean skin with alcohol • Remove the cap from the needle
• Pinch skin between your fingers
• Hold the needle like a pencil and go straight into the skin
• Slowly insert medicine by pushing the end of the syringe or pen
• Pull needle straight out and DO NOT rub the skin even if it is burning
• Throw away needle in a coffee can or a milk jug, NOT in the trash can

What to Do If You Skip Meals

• Try to AVOID skipping or delaying meals if at all possible
• If you MUST SKIP a meal you may need to adjust your insulin based on your blood  sugars
• Usually the R insulin, Humalog, Novolog, or Apidra are adjusted when a meal is skipped. 

What to Do If You Are Sick

• If you can’t keep food down you’ll need to adjust how much insulin you take based on  your:
  • blood sugars
  • if you can keep liquids down
  • may adjust all of your insulins.
  • do not skip all your insulin unless your doctor tells you to do this.

Thanks for completing the Insulin section! Take our quiz to see what you learned.

Take the Quiz!