The document provides guidance on proper storage, transportation, and injection technique for insulin. It discusses that insulin retains potency when stored at temperatures under 30°C for 2-4 weeks. Refrigeration is recommended for unopened insulin vials and pens. When traveling, insulin should be kept cool and never placed in checked baggage. The optimal injection technique involves rotating sites, using a small needle at a 90 degree angle, and ensuring the site is clean. Factors like temperature, exercise and injection site can impact absorption rate, but the mode of injection (pen vs vial) does not.

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OVERLOOKED ASPECTS OF INSULIN
THERAPY: STORAGE AND TECHNIQUE

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• Both in vitro and in vivo studies have showed no significant loss of potency of insulin
in vials stored at 25 and 26˚C till four weeks.
• Insulin in vials stored in mudpot (26˚C) retain the potency or biological activity.
• Results have showed that storage at higher temperatures (32 and 37˚C) decrease the
potency of insulin by 14 to 18 per cent.
• Loss of potency at 32 and 37ºC (room) temperatures start after three weeks. Thus
when storage cannot be assured at cool temperatures, insulin vials may be used only
for 2 wk.

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• Refrigerators should be placed at
least at an arm’s length away
from the wall, and also with
sufficient space in between them,
in the case of multiple
refrigerators and/or freezers, so
as to increase the air circulation.
• The refrigerator for insulin should
be defrosted every 6–8 weeks if it
is not self-defrosting
REFRIGERATION

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• Insulin pens and vials, which are not in active use, should
be refrigerated, but not frozen .
• Pens should never be stored with needles.
• In places where a refrigerator is not available, it is
advisable to put the vial in a plastic bag, tie a rubber
band, and keep it in a wide mouthed bottle or earthen
pitcher filled with water.

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• Insulin should be stored in a cool (below 30°C), dark place
and must be protected from extremes of temperature such
as direct sunlight, kitchen, closed cars, green houses, top
of the refrigerator, and television .
• Keeping a cool wet cloth around insulin helps to preserve
insulin potency.

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Insulin should never be kept immersed under water.
Immersing insulin under water after the vial has been
pierced carries a high risk of contamination, leading to loss
of potency and likelihood of causing injection abscesses
The water level should be below the neck of the vial, to
prevent possible leakage into, and contamination of, insulin
supply.
As the label tends to peel off when wet, one should use
waterproof tape to stick a label with the name of the insulin,
its expiry date, and its date of opening.

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SHELF LIFE

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Sanofi insulin
Insulin lispro injection: Pen and vial, throw away after 28 days
Insulin glulisine injection (Apidra®): 28 days
Insulin glargine injection (Lantus®): 28 days
Insulin glargine injection (Toujeo®): 28 days
Lilly insulin
Insulin Glargine (Basaglar®): Throw away pen/vials after 28 days, even if it still has insulin left.
Insulin Lispro (Humalog®): Throw away pen/vials after 28 days of use, even if there is still
insulin left.
Humulin R: Throw away vials after 31 days of use. If pen, throw away after 28 days.
Humulin N: Throw away vials after 31 days of use. If pen, throw away after 14 days.
Humulin 70/30: Throw away vials after 31 days of use. If pen, throw away after 10 days
Novo Nordisk insulin
Insulin aspart (Fiasp®, Novolog®, NovoRapid®): Pen and vial, throw away after 28 days.
Insulin degludec injection (Tresiba®): Pen and vial, throw away after 56 days.
Insulin detemir injection (Levemir®): Pen and vial, throw away after 42 days.
Isophane insulin human suspension: Vial – 42 days; pen – 28 days.
Insulin human injection: Vial – 42 days; pen – 28 days.
70% human insulin isophane suspension and 30% human insulin injection: Vial – 42 days; pen –
28 days.

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TRAVEL
• If the outside temperature is >30°C, insulin should be
stored in a flask with ice or in a proper container while
travelling.
• Do not keep insulin in a locked car or in the glove
compartment. Temperature in closed vehicles may reach
very high levels
• While travelling by air:
If time zone difference is 2 or more h, it may require a
change in insulin injection schedule.
Insulin should never be placed in the baggage hold of
the plane.Always carry it along in cabin.
The shelf life of insulin should be adequate for the
duration of the trip

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At the Beach or Other Summertime Outings
Leaving insulin in the bag on the hot sand, under the
hot sun, can absolutely cook and destroy the insulin.
At the very least Insulin should be in the shade on a
surface that isn’t naturally warm (putting a towel
beneath the bag)

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In very cold places
Keep it in an insulated thermos, cooler, or specially designed
storage pack to make sure that it stays above 40 degrees if
possible.
If you think that your insulin has frozen, it has to be thrown
away and not thawed and used !!

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In both cases the method of keeping insulin cool is not
recommended as it may result in the insulin freezing.
Moreover, the melting water will destroy the labels on the
insulin bottles
TRANSPORTATION

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TRANSPORTATION

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Figure showing plastic containers with cotton. This is an
improvised way of keeping insulin and syringes at room
temperature (20–30 C).
Insulin and syringes may be transported to work and to
school in the same plastic containers
TRANSPORTATION

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INSULIN TECHNIQUE

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INJECTION TECHNIQUE (OPTIMAL SEQUENCE)
• A lifted skin fold must be used if necessary .
• Push the needle at a 90° angle into the skin.
• For lean patients, combined use of a raised skin fold and
angled insertion is done.
• Avoid indenting the skin during the injection, as the needle
may enter the muscle .
• Administer insulin slowly and withdraw syringe needle at the
same angle.
• Hold the needle under the skin for at least 10 s after the
plunger has been depressed.
• Release skin fold .
• Dispose of used needle safely

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INJECTION SITE ROTATION
• Systematic switching of the injections from one site to another site optimizes
insulin absorption and reduces the risk of LH .
• A common and effective scheme is to divide the injection site into quadrants
(abdomen) or halves (thighs, buttocks, and arms).
• One quadrant or half should be used for 1 week and then move either in a
clockwise or an anticlockwise fashion to another quadrant or half, next week .
• New injection site should be at least 1–2 cm apart from the previous site.

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SKIN FOLD
Skin folds are considered when the presumptive distance
between the skin surface and muscle is less than needle
length
. Ideally, the thumb and index finger are used to lift a skin-
fold properly (possibly with the addition of the middle finger).
Use of the whole hand while lifting the skin risks lifting
muscle and can lead to IM injections

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WHAT IS THE BEST SIZE OF NEEDLE
TO BE USED IN INSULIN PENS IN
ADULTS ?
4CM
6CM
3 CM
8 CM

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NEEDLE SIZE

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Needle length recommendations for children,
adolescents, and adults
• Children, adolescents, and adults should use 4 mm needle
with pens and 6 mm needle with syringes .
• Children, extremely lean and elder patients warrants the need
of skin fold, especially when using 5 and 6 mm needle, but in
children, adolescent and adults, an injection angled at 45° is
required while using 6 mm needle.
• In adults, injection into limbs and slim abdomen warrants the
need for a skin fold with needles longer than the 5 mm .
• Shorter needle should be given at a 90° angle to the skin
surface .
• No clinical justification is available for recommending needle
length more than 4 mm for pen needles and 6 mm for insulin
syringes in adults .

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NEEDLE SIZE

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SYRINGE AND INSULIN MATCH
• In India, insulin is available in the strength of U-40 and U-100
concentrations. U-200 and U-300 insulins are also available but
only as pen. To avoid dosing errors, syringes that match the
concentration of U-40 and U-100 concentrations must be used
(A1).
• Insulin syringes of U-100 have an orange cover and black scale
markings denoting two units each, whereas U-40 syringes have a
red cover and scale marking denoting one unit each.
• Intravenous (IV) syringes must never be used for insulin
administration
• Date of opening the vial should be written with a black/marker pen
and the same should be used within a month.

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CLEANSING
• A knowledge, attitude, and practice (KAP) survey from
India, reported that 72.42% insulin users did not clean the
injection site beforehand.
• Before injection, the site should be thoroughly cleaned
either with cotton ball dipped in water.
• Cleansing should be started from the center and then
move outward in the circular motion.
• Alcohol if used(not necessary) for cleansing should be
evaporated completely, as the dry surface helps to
minimize or avoid pain.
• Do not use soap-based detergent, chloroxylenol, and
cetrimide/chlorhexidine to clean before injection.

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RESUSPENSION OF CLOUDY INSULIN
• A study conducted to evaluate how patients mix insulin
before injecting showed that only one person out of 180
patients could mix the insulin as per the manufacturers
recommendation. In 40% the opacity of the insulin varied
significantly from the expected value.
• Neutral protamine hagedorn (NPH) or premixed insulin
packaged in vials should not be shaken vigorously, but
should be repeatedly inverted for about twenty times, till
the suspension is uniformly clouded .
• In case of premixed insulin insulin should be resuspended
by rolling the pen and not be shaken.

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MIXING OF CLOUDY INSULIN
• Rolling the insulin between hands is a good way to mix
insulin in a vial without making a lot of little bubbles in the
insulin itself.e insulin by rolling the pen ten times, and then
pointing the pen up and down ten times. Is this really
necessary? Why?
• Insulin in pens is a little harder to mix than insulin in vials.
There are no air pockets to help the mixing process.
Insulin pen is to be mixed by rolling the pen ten times,
and then pointing the pen up and down ten times.There is
a tiny glass ball that rolls back and forth when the pen is
pointed up and down.

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PAIN!!!

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WHICH FACTORS DOES NOT AFFECT RATE OF
ABSORPTION?
SITE
TEMPERATURE
EXERCISE
MODE OF INJECTION (PEN OR VIAL)

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FACTORS AFFECTING RATE OF INSULIN ABSORPTION
• The order of the rates of absorption at the sites is abdomen
> arm > thigh > buttock.
• Factors which can speed up the absorption and cause
hypoglycemia are: hot environment, having a hot bath after
the injection, which increases blood flow to the injection
area, massage or exercise and IM injection of insulin.
• Factors which can slow down absorption and cause a
rise in blood glucose levels are :large volumes of insulin,
injections into damaged, unhealthy tissue, and cold
environments.

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THANK YOU