Teaching insulin injection technique

• Make sure the person assembles the pen, attaches the needle, dials the dose and gives the injection themselves.You may need to guide them - but don’t do it for them.

• Don't forget to do an air shot before each injection, especially if a new cartridge and/or needle has been fitted.An air shot will make sure the plunger is connecting, and expel air from the pen.

• If using intermediate or pre-mixed insulin, invert or rotate the pen at least 20 times to mix the insulin.

• Inject into clean skin with clean hands.Alcohol wipes are not recommended.Alcohol is an astringent and can make the injection more painful, as well as hardening the skin.
• To 'pinch up' or not to 'pinch up'? Insulin should be injected into soft fat, not muscle. To avoid intramuscular injection, slim people, or those using injection sites without much subcutaneous fat, may need to 'pinch up' and/or use a shorter needle length.

• Inject at a 90º angle.

• Push the needle in all the way.
• Needles come in 5, 6, 8, 12 and 12.7 mm lengths.Shorter needles reduce the fear of injections, and suit most people regardless of age or weight.A few people prefer longer needles, but they may need to ‘pinch up’ or inject at an angle less than 90º to avoid injecting into a muscle.
• After the injection, leave the needle in the skin for 5 to 10 seconds to avoid leakage.With large doses, it may need to be left in for longer.
• Occasionally, there may be bleeding after the needle is withdrawn. Reassure the person, and advise them to apply gentle pressure for a couple of minutes to minimise bruising. They should not rub the area, as this may increase the rate of insulin absorption

Demam Denggi Malay Leaflet

Leaflet Kempen Bahaya  Denggi ni saya ambil di pejabat kesihatan Kota Bharu

insulin treatment in Type 2 diabetes - Part 2

Insulin Type


Manufactured insulin can be either synthetic (human) or animal in origin, and falls into five main categories

• rapid-acting
• short-acting
• intermediate acting (also called isophane insulin)
• fixed mixtures (of rapid - or short-acting and intermediate-acting insulin)
• long-acting

Indications for insulin treatment

Strong indications for insulin therapy include:

• symptoms of hyperglycaemia such as polyuria, thirst, 
  recurrent fungal infections (especially genital thrush) or bacterial infections (especially urine infections
• pregnancy or planning pregnancy
• oral hypoglycaemic treatments not tolerated/ contra-indicated
• weight loss without dieting in someone of low or normal weight.

Possible indications for insulin therapy include:

•  unsatisfactory glycaemic control, even with the maximum tolerated dose of oral hypoglycaemic agents (OHAs) (HbA1c higher than 7 per cent, self blood glucose monitoring results higher than 7 mmols/litre before meals or 9 mmols/litre two hours after meals) 
• personal preference
• painful neuropathy
• foot ulceration and infection.

insulin treatment in Type 2 diabetes - Part 1

How Insulin Works

Put simply, insulin unlocks the ‘doors’ of cells to let the glucose in and it also suppresses liver glucose production. People with Type 2 diabetes may need supplementary injected insulin if they are insulin deficient and/or insulin resistant as a result of obesity or taking certain drugs, such as steroids, and where diet, physical activity and oral hypoglycaemic agents (OHAs) are no longer sufficiently effective in lowering blood glucose

Normal basal insulin secretion

The liver releases glucose at a relatively constant rate all the time, with a slight dip during the night and a surge before dawn.A steady release of insulin is therefore

needed to maintain normal blood glucose levels.

Normal meal-time insulin


As well as this 24-hour background insulin secretion, there is a burst of insulin at every meal -often called the meal-time bolus.Whenever glucose is released into the bloodstream from food, a matching release of insulin is required for up to two hours in order to move the
glucose into the cells. How long this increased insulin level is needed depends on the type of carbohydrate, its glycaemic index, and the fat content of the meal.

mechanism of insulin secretion

                          Normal Basal and Meal time insulin produced by pancreas

WOUND CARE GUIDELINES

The wound care guidelines have been developed by clinicians who are treating patients with wounds. They reflect current research and evidence based expert opinion.

The guidelines are intended for use as a resource for wound management and should be available to all medical,nursing and therapist caring for patients with wounds in Bolton Primary Care NHS Trust and Bolton Hospitals NHS Trust,Bolton Hospice and The Beaumont Hospital. Evidence based recommendations are included and a formulary of wound care products is included to promote rational prescribing.
These guidelines have been produced for use by any member of the healthcare team.

They are not intended as a substitute for professional judgement but are in support of the practitioner making an informed decision relating to the management of the patient,in accordance with individual professional competence.

Click at the book to download

Android Insulin Dose Calculator

Insulin Dose Calculator

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Ceftobiprole medocaril (Ortho-McNeil)

                         Fifth-Generation Cephalosporin

Another drug in development is ceftobiprole, which is in the midst of phase III trials for cSSSIs. Ceftobiprole is the first fifth-generation cephalosporin and also the first cephalosporin with activity against methicillin resistant Staph aureus (MRSA), according to Mark Kosinski, DPM, a Professor in the Department of Medicine at the New York College of Podiatric Medicine. Unlike other cephalosporins, ceftobiprole is designed to have a high affinity for PBP2a and therefore will be active against MRSA, adds Dr.Kosinski. As far as advantages go, he says the antibiotic offers gram-positive and gram-negative coverage, and also has a low potential to spur in vitro resistance.


The drug is parenteral only at this point, has good tissue penetration and has been shown to be active against Pseudomonas aeruginosa, according to Dr. Kosinski, a member of the Infectious Diseases Society of America.


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