Assemble all equipment. Then wash your hands with warm water and soap.



If you're using intermediate-acting or long-acting insulin, gently roll the bottle between your hands. Never shake the bottle. If you're using regular insulin, skip this step.

Clean the top of the bottle with alcohol. let it dry so that you don't inadvertently introduce alcohol into the insulin.

Inject an amount of air into the bottle equal to the amount of insulin to be drawn up.

If you're mixing more than one type of insulin, draw up the regular insulin first. Be sure to draw up the proper amount of insulin. If you see air bubbles in the syringe, gently tap it with your finger and push lightly on the plunger.

Clean the injection site with alcohol or warm water. If you use alcohol, let it dry before injecting the insulin.

Spread the skin at the injection site. Smoothly inject the needle at a 90-degree angle.

Withdraw the needle and immediately apply pressure to the injection site with a cotton ball or alcohol swab. Don't massage the area.

Discard the needle in a puncture-resistant container, such as a coffee can.

Sodium

The American Diabetes Association recommendations for sodium, less than 3,000 mg per day, are no more restrictive than is common for the general population. Patients with diabetes who also have hypertension should ingest no more than 2,400 mg of sodium per day.

Common Caloric Sweeteners

Sweeteners are classified as caloric or noncaloric. Sucrose, fructose, and alcohol sugars are the most common caloric sweeteners. Caloric sweet- eners are no longer banned from the diets of patients with diabetes. But if your patient consumes sucrose or fructose, she must exchange it for another carbohydrate. Just like other sources of carbohydrate, sucrose and fructose provide 4 calories per gram. However, your patient shouldn't consume more than 5% of her daily carbohydrate calories in the form of caloric sweeteners.

Sugars in alcohol-sorbitol, xylitol, and mannitol-have little effect on blood glucose levels. Your patient shouldn't include them when calculating the carbohydrate content of foods. She also shouldn't use them to treat hypoglycemia.

Patients with diabetes may eat all the noncaloric sweeteners currently approved for use in the United States- aspartame, acesulfame K, and saccharin. They contain virtually no calories and have a negligible effect on blood glucose.