DIRECTIONS FOR THE USE OF INSULIN
Insulin is an aqueous solution of the active anti-diabetic principle derived from the islands of Langerhans of the pancreas. This
extract, when injected subcutaneously into a human diabetic, enables the patient to utilize carbohydrates in a normal manner.
Insulin is prescribed in units in terms of which its strength is expressed. Each unit of Insulin will enable a diabetic patient to utilize
an average of from one to one and a half additional grams of carbohydrate; but the additional amount of carbohydrate so utilized will
vary in individual patients and according to circumstances.
The number of units of Insulin contained in each cubic centimetre (cc.) of solution is clearly stated on the label of each vial, and
should be carefully noted before the solution is withdrawn.
Insulin is only an adjunct to the dietary treatment of diabetes, and as with diet so with Insulin, the success attained will depend
largely on the intelligence and co-operation of the patient. Generally speaking, it is best given 15 to 30 minutes before a meal, either
once, twice or three times daily according to the severity of the diabetes.
DIRECTIONS FOR THE ADMINISTRATION OF INSULIN
(1) Cleanse site of injection with soap and water, apply suitable antiseptic solution, such as Tincture of Iodine or Alcohol.
(2) Use only freshly sterilized hypodermic syringe and needle (sterilized preferably by boiling).
(3) Withdraw Insulin from the vial container, observing the following directions:-
(a) Wipe the surface of stopper with 5% Carbolic Acid solution or Tincture of Iodine, before piercing cap with sterile needle.
(b) Draw into the syringe an amount of air equal to the amount of Insulin to be withdrawn from the vial.
(c) Pierce the depression in the centre of the rubber stopper with the sterile hypodermic needle of the syringe,
and push the needle forward in a straight line. Then invert the vial and inject into it the air contained in
the syringe. Keeping the point of the needle immersed in the Insulin, withdraw the required amount. Do
not remove stopper.
(4) Carefully insert the needle into the loose subcutaneous tissue, and slowly inject the required dose of Insulin.
Caution.-Lack of observance of the above details may lead to contamination of the Insulin and danger of infection
to the patient.
TIE REMARKABLE LOWERING OF BLOOD SUGAR BY INSULIN MAKES EXTREME CAUTION NECESSARY IN ITS ADMINISTRATION
When insufficient carbohydrate is present in the body in relation to the Insulin administered, the blood sugar becomes excessively
low (hypoglycaemia). This condition may result:-When food is not being absorbed (starvation, vomiting, diarrhoea, or delayed
digestion); when Insulin is given too long before or after meals; when large doses of Insulin are given too close together; when the
natural tolerance (the patient's own Insulin production) increases; or when excessive exercise is taken. This untoward result of Insulin
administration may usually be avoided by careful treatment, or if it is developing, it may be easily controlled by the simple remedies
given below. If neglected, it may give rise to serious consequences. No patient unfamiliar with the symptoms of hypoglycaemia should
use Insulin, and the remedies for the condition should be readily available to him at all times.
The early symptoms of hypoglycaemia consist of hunger, weakness, or fatigue coming on suddenly, or perhaps a peculiar sense of
uneasiness, nervousness or tremulousness. These may be accompanied by pallor or flushing of the face and body, wide pupils and,
especially in children, an increase in the rate of the heart beat. The juice of an orange, two or three pieces of candy, or a tablespoonful
of corn syrup controls this condition rapidly.
If unchecked, some of the following symptoms appear. As the blood sugar falls to lower levels, sudden sweating occurs (a most
characteristic symptom), and the patient realizes that he cannot make fine movements with exactness. Anxiety, fear, excitement, and
emotional disturbances may occur, often accompanied by dizziness or double vision. A somewhat larger dose of the same remedies
may be used and repeated if relief is not experienced within fifteen minutes.
A physician should be summoned at once if the patient becomes delirious or mentally confused or suffers from loss of memory or
delusions, as these conditions may precede a collapse or unconsciousness or even death. If the patient can swallow, dilute corn syrup
or the juice of several oranges with added sugar should be given immediately. These should be given by stomach tube if necessary.
If the patient becomes unconscious and is in a critical condition, from 10 to 30 grams of glucose should be given intravenously in a 10 to
50% sterile solution. Suitable adjustment of the subsequent dose of Insulin should be made if hypoglycaemia is encountered in a patient.
Insulin should be used only on the order of a physician. Insulin-Toronto of four different strengths is supplied in 10 cc.
vials-20 units in each cc., 40 units in each cc., 80 units in each cc., or 100 units in each cc. In ordering, specify strength
and amount of Insulin desired. In writing or reporting regarding effects obtained with the contents of any vial, always
refer to the lot number which is marked on the label of the vial.
Dosage of Insulin should always be expressed in units rather than in cubic centimetres or minims. The volume of any one prescribed
dose of Insulin will vary with the strength of the solution which is employed.
University of Toronto Toronto, Cinada