What are reasons for 10 second rule when injecting...

[Ambersilva]

Hi @Molly56

I am assuming your partner uses a modern pen?
The mechanism in these devices have a "smoother action" regarding insulin delivery these days.

But, if one was to do an "airshot" of (for instance) 10 units? (An airshot of 2u is always done prior to injection to prime the needle & expell any trapped air.)
The stream of insulin will fire into the air, and as the insulin jet drops off when the plunger in the barrel pushing the bung comes to rest. You should then see a couple of droplets emerge from the end of the needle..? There may be a split second delay in this action.
So the ten second rule is to allow "absorption" as mentioned by my good fellow injectors earlier. Thus ensuring the correct dose....

AS ever @Jaylee with your long term experience and succinct way of explaining things that us less experienced members of the the D club can only aspire to.

 

[himtoo]

@Jaylee ...thanks for comments....this raises another issue about injection technique....my partner never (and I mean, never) does the 2 unit airshot before dialling up dose and injecting....just wondered how much this matters ....could air in the needle potentially cause pain or discomfort when injecting or affect absorption of insulin...

it does matter -- not doing an airshot means your partner could just be injecting air instead of insulin ( sometimes a 10u airshot has been required by me to get insulin coming out the needle tip )

 

[eddie1968]

All injections need to to be primed by an airshot, your DSN and the insert for your insulin explain this. If you are doing a mixed insulin like me you must shake it thoroughly as described to agitate it to a cloudy appearance. Different strokes for different folks.

 

[Molly56]

@eddie1968 @himtoo @Jaylee @hels and others.....thank you for all your answers...seems the airshot is something vitally important that he seems to be avoiding....dsn did tell him on initial insulin appointment and he has read leaflet but I still notice that he fails to do this on almost every occasion .....
.....the big question is how do I mention it (and the 10 second rule) without him thinking I am interfering or criticising and without him biting my head off! (a definite possibility....he gets very tetchy if I say too much about this).....or do I just keep quiet and let him get on with it...is a tricky one...
...personally if I was to mention just one I think the airshot is the first issue to tackle....may just suggest this would help to reduce discomfort on injecting next time he experiences this....not sure if it will or not but could be contributory factor and he won't know if this is true or not...
....always have to be careful what I say to prevent him going back to total denial mode.....thanks again for all your advice

 

[eddie1968]

Molly, maybe a cattle-prod for your uncooperative hubby lol

 

[Molly56]

Molly, maybe a cattle-prod for your uncooperative hubby lol

@eddie1968 ....a cattle prod is a great suggestion.....I still fail to understand why he can't get up until mid morning at the earliest and then feels the need to return to his bed on a number of occasions during the day ....he has gone back to bed now....perhaps a cattle prod is just what I need........do they sell them on EBay (or similar auction websites) lol.....

 

[eddie1968]

@eddie1968 ....a cattle prod is a great suggestion.....I still fail to understand why he can't get up until mid morning at the earliest and then feels the need to return to his bed on a number of occasions during the day ....he has gone back to bed now....perhaps a cattle prod is just what I need........do they sell them on EBay (or similar auction websites) lol.....

It's probably his blood sugars - if they are high and he is not doing his insulin on time and correctly he will have no energy and will crawl back to bed.

 

[silverbirch]

Hi @Molly56, you don't mention what his b/g readings are. If they are within range, then he must be doing something right, what ever method he uses. Just a thought.

 

[ButtterflyLady]

@eddie1968 @himtoo @Jaylee @hels and others.....thank you for all your answers...seems the airshot is something vitally important that he seems to be avoiding....dsn did tell him on initial insulin appointment and he has read leaflet but I still notice that he fails to do this on almost every occasion .....
.....the big question is how do I mention it (and the 10 second rule) without him thinking I am interfering or criticising and without him biting my head off! (a definite possibility....he gets very tetchy if I say too much about this).....or do I just keep quiet and let him get on with it...is a tricky one...
...personally if I was to mention just one I think the airshot is the first issue to tackle....may just suggest this would help to reduce discomfort on injecting next time he experiences this....not sure if it will or not but could be contributory factor and he won't know if this is true or not...
....always have to be careful what I say to prevent him going back to total denial mode.....thanks again for all your advice

If I were you I would say nothing unless he complains about something specifically, then you can gently ask - has he tried doing it this other way? I can't stand it when well-meaning people tell me what to do... but if I say something is not going well for me, then that is the time when I am open to suggestions.

It's important to have good healthy boundaries, where each person focuses on their own issues and lets the other person focus on theirs.

 

[iHs]

@Molly56

Although I now use an insulin pump, I sometimes use an insulin pen if need be. In the 50yrs I've been type 1, I don't think that I've ever done an air shot. I just make sure that I can see a droplet of insulin at the end of the needle, dial up the units I need and theninject. I use a Lilly Humapen Luxura which takes pen cartridges. I also very rarely hold the pen needle in my skin for more than 2-3 secs. It's in and out lol

 

[Molly56]

Hi @Molly56, you don't mention what his b/g readings are. If they are within range, then he must be doing something right, what ever method he uses. Just a thought.

@Molly56
Although I now use an insulin pump, I sometimes use an insulin pen if need be. In the 50yrs I've been type 1, I don't think that I've ever done an air shot. I just make sure that I can see a droplet of insulin at the end of the needle, dial up the units I need and theninject. I use a Lilly Humapen Luxura which takes pen cartridges. I also very rarely hold the pen needle in my skin for more than 2-3 secs. It's in and out lol

Just to answer some recent posts on this topic..

@silverbirch ...his bs readings are generally somewhere between 7 and say 12....with a few in the 15 - 16 range....over the past couple of weeks morning readings have been from 7.4 at their lowest to 10.1 and pre dinner readings from a low of 7.0 to a high of 16.5 .......he seems to be uncomfortable with them going below 10 saying that makes him "feel ill and is not right for his body"....personally if it was me I would want them to be down further towards non-diabetic levels....but as someone will no doubt remind me, it is not me....

@iHs ....this sounds similar technique to my partner...I did casually question about the airshot and air in the needle the other day but he said that when he dials it up a bubble appears at the end of the needle so this is probably referring to the droplet that you mention...I have also noticed that he is perhaps holding it in for longer than I first thought so perhaps it is ok here though not for the 10 seconds as recommended....
....in terms of the pain on injecting he puts this down to probably being the angle at which he is holding and inserting the pen needle and perhaps is learning in his own way how best to do this...

Thank you to everyone else for your valuable input on this topic ....hopefully some small tweaks in terms of injection technique will help to make sure the insulin is doing its job effectively.

 

[silverbirch]

...his bs readings are generally somewhere between 7 and say 12....with a few in the 15 - 16 range....over the past couple of weeks morning readings have been from 7.4 at their lowest to 10.1 and pre dinner readings from a low of 7.0 to a high of 16.5 .......he seems to be uncomfortable with them going below 10 saying that makes him "feel ill and is not right for his body"....personally if it was me I would want them to be down further towards non-diabetic levels....but as someone will no doubt remind me, it is not me....

Hi @Molly56, Ok, so some of his readings are high and should be in single figures, but that would suggest to me that maybe he is not matching his bolus to his carbs. I understand about him saying that low numbers make him feel ill, and to him it would feel this way because he is used to his bg being high, so anything going lower will make him feel wobbly. I myself feel happiest in my body when it is slightly higher, say 7.0 and not 5.0, we are all different, but I guess in time he will get used to lower numbers. It is a scary thought that when your numbers are low you are in the realms of going into hypo... I hate those times. I can see why you are concerned but until your partner learns that lower numbers are ok and it is only because he is used to high numbers, then all anyone can do it be there when he needs your help. Frustrating as that may be, it is all you can do. May be you can agree with him that for now 10.0 is ok, it's a start and a lot better than 12.0 - 15.0 - 16.5. As for the pain when injecting, it does hurt more in some areas than others. I usually just rest the tip of the needle onto my skin, if it hurts I try somewhere else. I usually find a spot that causes me no pain using this method. Hope you find a solution that helps you both. Good luck.

 

[Molly56]

Ok, so some of his readings are high and should be in single figures, but that would suggest to me that maybe he is not matching his bolus to his carbs.

@silverbirch...just to clarify one point where you mention not matching bolus to carbs....he is on Novomix 30 (mixed insulin) and takes 28 units effectively at lunchtime (should be morning but he skips breakfast / doesn't get up till late morning) and another 28 units pre evening meal....these are set doses as agreed with nurse and no account is taken of amount of carbs or any adjustment made....and to my knowledge he has not been told to do this so far....

....on a positive note he has cut out some carbs particularly here at home but I am aware of some carbs sneaking in when he is out about (have seen the receipts!)......do sometimes wonder if he should be keeping track of carb intake to check that insulin dose is appropriate as is also potential that he is taking too much insulin for number of carbs being consumed.....I guess this is where carb counting comes in........some of the prepacked salads he is choosing to eat for his dinner have minimal carbs.(less than 10g in some cases).......certainly since starting on the insulin he is eating far less carbs than he originally was but I don't know if this information has been related to the dn (I doubt it)......

....unfortunately due to other work or family commitments I have not been able to attend recent appointments with him with diabetic nurse where I could pose this question ...and hear what she has told him (he never remembers...)....the last appointment had a post it note message stating "10g = 2mmols ; 1 unit insulin = (downward arrow) 2-3 mmols ; Carbs & Cals book" but he doesn't remember at all what this means or has not taken any different action to what he was doing before that appointment.....would be useful to have the opportunity to know and ask....my guess is that she was heading him down the carb counting route but that is just not happening...

I have as you say come to the conclusion that 10 is better than the higher figures and generally just letting him get on with it....am just educating myself on what can potentially happen so that I am in a better place if I need to deal with any consequences....

 

[Ambersilva]

...the last appointment had a post it note message stating "10g = 2mmols ; 1 unit insulin = (downward arrow) 2-3 mmols ; Carbs & Cals book"

My interpretation of the note from the DSN:

10 grams of carbohydrate raises blood sugar 2 mmols. For example from 5 up to 7 mmols on the meter reading
1 unit of insulin lowers blood sugar 2 to 3 mmols. For example from 10 down to 8 or 7 mmols on the meter reading

The Carbs & Cals book or app is a very good guide to carbohydrate content of food with illustrations of portions on a plate.

 

[Molly56]

Have noticed in recent days that injection routine has become more and more erratic...

....as I understand it he should be testing and injecting immediately before eating but this is just not happening.....in fact last night it was well over an hour after he had eaten that he remembered to do his injection ......and he did this without testing his bs first.

....it seems not testing before evening meal is now becoming a regular occurrence even though I see that he has written a number in his book (some of which are clearly fictitious and don't agree with what it says on the meter!)...

....question is.....should I say anything or just leave him to get on with it....also what effect does injecting so late after a meal have in terms of how the insulin works....

 

[ButtterflyLady]

Have noticed in recent days that injection routine has become more and more erratic...

....as I understand it he should be testing and injecting immediately before eating but this is just not happening.....in fact last night it was well over an hour after he had eaten that he remembered to do his injection ......and he did this without testing his bs first.

....it seems not testing before evening meal is now becoming a regular occurrence even though I see that he has written a number in his book (some of which are clearly fictitious and don't agree with what it says on the meter!)...

....question is.....should I say anything or just leave him to get on with it....also what effect does injecting so late after a meal have in terms of how the insulin works....

I would ask him if he wants help with it, and if he says no, I would try to leave him to it, hard as that is to do in practice.

 

[tim2000s]

It seems that your partner is unfortunately going back to his bad old ways, only this time with insulin involved. Your assistance last time didn't lead to any changes, so unless there is a sudden change of affairs, it doesn't look like it will make any difference. Sorry to be blunt @Molly56 , but that's how it looks from outside.

The mixed insulins are designed to assist with eating and provide a background insulin. Taking them before eating should stop or reduce any post-prandial bg spikes, limiting the damage that these do. By leaving the insulin till an hour after he eats, the short acting component is having an effect from about two hours after he eats and peaking about three hours after he eats. In the meantime, his digestion is probably peaking around two hours after he eats (dependent on what he eats), which means that if he was to test at meal+2 hours (which given what you've said, I very much doubt he is), you'd probably see BG levels in the high teens/low twenties.

It doesn't change the way the insulin works, it just changes the way the blood glucose levels change.

The fact that he isn't testing before injecting also suggests that he doesn't want to see how high his blood sugars really are as he is in his usual Ostrich pose.

The issue with mixed insulins is that for them to work effectively, they have to be used in a fairly strict routine. If they aren't, then BG levels will be jumping and while they might be coming back down, they are likely to be higher than they need to be. In other words, he is not really reducing the damage that he is doing to himself.

 

[Molly56]

It seems that your partner is unfortunately going back to his bad old ways, only this time with insulin involved. Your assistance last time didn't lead to any changes, so unless there is a sudden change of affairs, it doesn't look like it will make any difference. Sorry to be blunt @Molly56 , but that's how it looks from outside.

The mixed insulins are designed to assist with eating and provide a background insulin. Taking them before eating should stop or reduce any post-prandial bg spikes, limiting the damage that these do. By leaving the insulin till an hour after he eats, the short acting component is having an effect from about two hours after he eats and peaking about three hours after he eats. In the meantime, his digestion is probably peaking around two hours after he eats (dependent on what he eats), which means that if he was to test at meal+2 hours (which given what you've said, I very much doubt he is), you'd probably see BG levels in the high teens/low twenties.

It doesn't change the way the insulin works, it just changes the way the blood glucose levels change.

The fact that he isn't testing before injecting also suggests that he doesn't want to see how high his blood sugars really are as he is in his usual Ostrich pose.

The issue with mixed insulins is that for them to work effectively, they have to be used in a fairly strict routine. If they aren't, then BG levels will be jumping and while they might be coming back down, they are likely to be higher than they need to be. In other words, he is not really reducing the damage that he is doing to himself.

@tim2000s .....had noticed that pile of sand at the bottom of the garden had reappeared and suspected that he is suffering from HISS.....head in sand syndrome....not much I can really do about it other than to let him get on with it and advise if and when appropriate to do so...
....guess some insulin + some testing is better than no insulin + no testing.....thank you for your reply...