In recent years, diabetes has become a worldwide public health problem that seriously threatens human health. Insulin is the main drug for the treatment of diabetes, and patients often need lifelong medication to maintain their normal body metabolism and physiological functions. Therefore, it is very important for nursing staff to master the relevant knowledge and injection skills of insulin hypodermic syringes. From the perspective of nursing, this paper reviews the nursing progress of subcutaneous insulin injection instruments and injection methods.
The hypodermic injection of insulin is suitable for the parts with loose skin. Commonly used injection sites are the upper arm triceps, abdomen, outer thighs, buttocks, back, etc. Different injection sites have different absorption and effect of insulin. Among them, the abdomen is the fastest, followed by the upper arms, buttocks and thighs. It is generally believed that this difference is related to local blood flow. The researchers studied the absorption rate of subcutaneous insulin injection in the upper abdomen, upper abdominal wall, and thigh, and believed that leg exercise could increase the absorption of insulin in the legs without affecting the absorption of insulin in the upper arm. Absorption is faster when the limb is in motion than at rest. Plasma insulin peaks after 1 hour at rest, and peaks within 40 to 50 minutes during exercise. Therefore, when the patient is just exercising or before preparing for activity, injections on the limb that will be active should be avoided. Studies have shown that the absorption of insulin in the abdominal wall is the fastest, reaching 50% in 8 minutes, followed by the upper arm for 14 minutes and the buttocks for 14 minutes. Insulin injection at the same site for a long time is likely to cause local swelling and induration, which affects the absorption of insulin, so the injection point should be changed frequently. The specific method is to select the buttocks, the outer side of the upper arm, the abdomen and the outer side of the thigh. Each site can be divided into 15 injection points, calculated as 3 injections per day, each site for 5 days, and another site after 5 days.
The researchers compared the traditional oblique needle subcutaneous injection method of insulin with the vertical subcutaneous injection method, and confirmed that the vertical subcutaneous injection method can reduce the degree of local pain and reduce the incidence of local adverse reactions, and is a more suitable subcutaneous injection method for diabetic patients. The specific injection method of the disposable insulin syringe: select the injection area, sterilize it with 75% alcohol, let it dry, gently pinch the local skin with the thumb and index finger of the left hand to form a fold, pierce the needle vertically at the top of the fold, and return it to the fold. No blood is drawn, that is, push the medicine slowly. After the medicine is injected, relax the skin and pull out the needle for about 1/3 and then stay for 15s to ensure that the medicine is injected. Then quickly pull out the needle according to the original needle insertion angle, and press the cotton ball for 3 minutes, and the strength is based on the skin subsidence 0.5cm.
Under normal circumstances, the sterile insulin syringe starts to take effect 45 minutes after the injection of insulin, reaches the peak at 2 hours, and lasts for 6 hours. The selected time is usually 30 minutes before meals. Some researchers suggest that subcutaneous injection of regular insulin 15 minutes before meals is more appropriate than 30 minutes before meals. Compared with the two injection methods, there was no significant difference in blood glucose before and 2 h after a meal, and the hypoglycemic response rate of the former was significantly lower than that of the latter. Another study pointed out that after breakfast with poor islet function, patients with hyperglycemia and nocturnal hyperglycemia can change the insulin injection time to 1 hour before meals. In addition, the insulin injection time must be determined according to the patient's blood sugar. If the blood sugar is below 4.4mmol/L, eat immediately after injection, otherwise hypoglycemia will occur.
When adjusting insulin dosage, follow the principle of blood sugar rather high than low. The distribution of short-acting insulin for three meals is: more before breakfast, least before lunch, and middle before dinner. When using premixed insulin preparations, it is advisable to inject 2/3 before breakfast and 1/3 before dinner. When changing from animal insulin to human insulin, it may be necessary to appropriately reduce the dose (reduce the original dose by 1/3), and generally adjust the dose once every 3-5 days (or 1-2 days). should be reduced in time. When starting insulin, use short-acting insulin for multiple injections, and then switch to other dosage forms after satisfactory control. Eat small amounts of carbohydrates before bed to prevent nighttime hypoglycemia.