When recently diagnosed with an insulin-dependent type of diabetes, insulin injections are often intimidating. At first, you may have to overcome your fear of needles and are probably scared not to do your subcutaneous injections correctly.
Insulin is available with different injection devices, including prefilled pens, vials, and insulin pumps. The pens are now widely used, but some patients are still prescribed vials of insulin.
Insulin vials are a bit trickier to use than pens because they require specific handling, such as drawing insulin from the vial into the syringe.
While drawing up insulin is within everybody's reach, it must be done correctly and safely. That's why we've put together this step-by-step guide on how to draw up insulin. Ten easy steps to follow!
Related article: Does insulin need to be refrigerated, and how to store it properly?
How to Draw up Insulin: Step-by-step Guide
When you receive insulin therapy through syringes, which is still the case for many people living with diabetes, you must draw the insulin from the vial into the syringe to prepare your subcutaneous injection.
While this gesture will quickly become automatic as you repeat it over time, it can be intimidating at first. Drawing up insulin is quite simple, but it must be done right to ensure you're administering your total dose of insulin correctly.
So, let’s go back to the basics in this step-by-step guide to drawing up insulin from a vial.
Related article: A step-by-step guide to using an insulin pen
Step 1: Take the insulin out of the fridge
As you know, insulin is a temperature-sensitive medicine that must be stored in the refrigerator before first use and protected from heat and light when in use.
That said, injecting cold insulin from your fridge may be more painful. So, if you're using a brand new, unopened insulin vial, remove it from the refrigerator and let it sit at room temperature for about 30 minutes before preparing your syringe for the injection.
Related article: How to store insulin correctly?
Step 2: Gather injection supplies and wash your hands
The next step to drawing up insulin from a vial is to prepare your injection material on a clean table when you can sit comfortably. That includes:
- Your insulin vial
- A new insulin syringe
- Alcohol wipes
- A sharps container
- Your diabetes logbook, if you have one
Preparing everything beforehand and making sure you have all you need within easy reach helps reduce injection stress and get through it calmly, especially at the beginning.
Once everything is ready, wash and dry your hands.
Related article: 10 tips that work to inject insulin without pain!
Step 3: Double-check your insulin syringe
There are over 20 different types and brands of insulin available on the market. While the majority are U-100 insulins (meaning they have a concentration of 100 units of insulin per milliliter of solution), some may have a different concentration, such as U-200 or U-500 insulins.
Insulin syringes differ from any medical syringe, as they are graduated in units instead of milliliters. If you've been prescribed U-100 insulin, you must use a U-100 insulin syringe. Otherwise, the quantity of insulin you're drawing up from the vial will be wrong, which can seriously affect your blood sugar levels.
Your pharmacist should have provided you with suitable syringes. But it's always good practice to double-check and make sure you use the correct syringe for your type of insulin.
Related article: How to convert insulin units to mL?
Step 4: Roll the insulin vial if necessary
Among the many different types of insulin, some are clear-looking, and others are cloudy (mostly intermediate-acting types of insulin).
Cloudy insulin and premixed insulin must be mixed before the injection. Gently roll the vial between your palms about 10 times until the suspension is mixed. Do not shake too hard, as it could create air bubbles.
Related article: Clear vs. cloudy insulin: why it matters!
Step 5: Clean the rubber top of the insulin bottle
Before drawing insulin from a vial, clean the rubber top of the bottle with an alcohol swab. Remove the hard plastic cap if you're using a new bottle.
Insulin vials are made with very thin glass that easily shatters when dropped on hard floors. Besides, once open, their top surface is not protected and stays in contact with the ambient air. As a result, dust may accumulate, and biological contamination could happen.
To protect your insulin vials from breaking and getting dirty, we recommend using a silicone vial protector with a sanitary lid like the ones below.
Step 6: Always use a new insulin syringe
The next step before drawing up insulin is to prepare your insulin syringe. Remember that insulin syringes are disposable and made for single use only.
Reusing the same syringe for several insulin injections can cause skin infections, pain at the injection site, and other complications. Therefore, always use a new needle for every shot.
Step 7: Inject air into the insulin vial
Injecting air into the insulin before drawing up the liquid medicine helps reduce air bubbles and makes the process easier by correcting the bottle's pressure.
Remove the syringe cap, pull back on the syringe plunger, and draw in an amount of air equal to the amount of insulin to be injected (your insulin dose). Next, push the needle into the bottle rubber top and inject air into the vial by depressing the plunger. Do not remove the needle.
Step 8: Draw up insulin into the syringe
The next step is to draw up your insulin dose into the syringe. With the needle still in the vial, turn the vial and syringe upside down. Pull back on the plunger and fill the syringe with a little bit more than the insulin units you need.
Step 9: Remove air bubbles
Removing air bubbles that may be present in your insulin syringe is essential and must be done before any injection. This step is called “priming” the syringe. It helps ensure the needle is working (not blocked) and you get your full dose of insulin.
Air bubbles in insulin pens or syringes often happen because of changes in temperature, atmospheric pressure, shaking, or vibrations. When there are bubbles in your insulin syringe, they take up the space of the insulin. If you do not remove them before your injection, you'll inject too little insulin (your dose of insulin minus the volume of the air bubbles). Ultimately, priming your insulin syringe considerably improves insulin dose accuracy and blood sugar control.
To remove air bubbles in an insulin syringe, flick or tap the syringe with your finger, so the bubbles gather at the top. Then, inject in the air until the first drop of insulin comes out of the needle, and readjust your insulin dose.
Related article: Why and how to prime your insulin pen?
Step 10: Inject your insulin
Once you've drawn insulin into a syringe, you should inject it immediately. However, some patients may need to prefill insulin syringes in advance for later use. That can be done under certain conditions. Please read our related article on the topic:
Related article: Can you prefill insulin syringes, and how long are they good for?
Which insulin do you draw up first?
Several types of insulin have different lengths of action, onset times, and purposes. For example, while long-acting or intermediate insulin (basal insulin) helps control fasting blood sugar, rapid or short-acting insulin (bolus insulin) works on after-meals glycemia.
Related article: A beginner’s guide to basal and bolus insulin
In some cases, when you've been prescribed two different types of insulin, you can mix them together in the same syringe to reduce the number of daily injections.
In that case, you must always draw the clear insulin (intermediate, NPH) before the cloudy one (regular, short-acting).
Only mix two insulins if your doctor has expressly advised you to do so. Some insulins can't be mixed together.
Related article: How to mix two insulins into one syringe?
Can you draw insulin from a pen?
Drawing insulin from an insulin pen is not recommended. All insulin manufacturers advise patients not to do so.
Insulin vials and pen reservoirs do not work in the same way. Insulin vials are pressurized and designed for insulin to be drawn out. On the contrary, prefilled insulin pens and cartridges are not pressurized. Instead, they're designed for insulin to be pushed out.
Drawing insulin from a pen with a syringe can interfere with the pen's functioning and cause problems with dose accuracy. Only do it in an emergency and if you do not have any other way to get your insulin shot.
Related article: What to do if you run out of insulin?