1. Insulin preparations are categorised according to their action profile:
There are also premixed insulins which contain a mixture of quick-acting and intermediate-acting insulin. Insulin preparations are available in vials, cartridges and disposable pens.
2. It is important to rotate your insulin injection sites in order to prevent lumps and hardened tissue from forming. Injecting into lumps or hardened tissue affects the absorption of insulin, making it less effective.
3. Reminders for insulin:
Insulin is administered by subcutaneous (just under the skin) injection. It should only be used when prescribed by a doctor and dose adjustments should be supervised.
All about Insulin
Whilst type 1 diabetes is irreversible, with insulin replacement, individuals may learn to manage their condition and live long, healthy lives.
During sleep or in between meals, small amounts of insulin are produced every few minutes (basal insulin), 24 hours of the day.During mealtimes, larger amounts of insulin are produced in response to glucose loads (bolus insulin). See figure below.
In those with type 1 diabetes, there are thus 2 components to insulin replacement: the basal insulin dose and the bolus insulin dose.
Individuals with type 1 diabetes ought to be on a basal-bolus regimen with quick-acting insulin delivered in multiple doses throughout the day. (Refer to pg 51 for the types of basal and quick-acting insulins available)
Another mode of delivery of insulin is through continuous subcutaneous insulin infusion via an insulin pump. (Refer to pg 64 for more information on insulin pumps)
Types of Insulin
There are many types of insulin available in Singapore. The ones presented in this booklet represent what is presently registered and available in Singapore.
Insulin is administered by subcutaneous (just under the skin) injection. Insulin should only be used when prescribed by a doctor and dose adjustments should be supervised.
Insulin preparations can be categorised according to their time action profile: quick-acting, intermediate-acting and long-acting. There are also premixed insulins which contain a mixture of quick-acting and intermediate-acting insulin.
Insulin preparations are available in vials, cartridges and disposable pens.
Low blood glucose levels may happen when there is a mismatch of carbohydrate intake to insulin, during exercise, after alcohol intake, or in relation to other medical conditions. |
The tables below show the types of insulin available in Singapore as well as their:





Insulin pen (preparation and administration)
1. Wash your hands and prepare these items.
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2. Clean the tip of the pen with an alcohol swab and attach the needle.
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3. Remove the outer needle shield but do not throw it away. Prime the pen by turning the dose knob to 2 units, holding the pen with needle plinting up, and pushing the dose knob in.
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4. A drop of insulin should appear at the top of the needle.
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5. Turn the dose knob to the number of units you need to inject. The dose indicator line should line up with your dose.
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6. Following the injection, the used needle should be led towards the needle shield, which is then capped. Unscrew the needle with the meedle shield on.
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7. Discard the used needles in a puncture resistant container.
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Note that premixed insulin is cloudy than clear. For this premixed insulin, roll the pen 10 times and invert the pen up and down 10 times to ensure that this is well mixed before use.

| 1. Wash and dry your hands. | 2. Check that you have the correct type of insulin pen. Check the expiry date. |
| 3. Check your dose of insulin prescribed. Perform the safety check and turn to the correct amount. | 4. Select and inspect the injection sites for any lumps or hardened areas, redness, swelling or scar tissues. Do not inject into these areas.
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| 5. Clean the injection site with an alcohol swab. | 6. Wait for the alcohol to dry. |
7. Gently lift a skinfold. Not everyone will need this step. Check with your healthcare provider.
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8. Hold the insulin pen at a 90-degree angle perpendicular to the skin.
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| 9. Inject the insulin by pushing the dose knob down gradually at a steady speed. Count for 10 seconds after the plunger is fully depressed. Withdrawing the pen needle at the same angle it was inserted, release the skinfold. | 10. Place the outer needle shield on a table, direct the used needle into the needle shield and cap the used needle before unscrewing the needle for disposal. This is to prevent finger-stick injuries. |
11. Discard the used insulin needle in a puncture-resistant sharps container and seal it before disposal.
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| Insulin | Storage | Remarks |
| Insulin in-use | At room temperature (max. approximately 25-30°C) For Novorapid FlexPen and Penfill, Lantus Solostar, Novomix FlexPen, Apidra Solostar: Discard 4 weeks after opening For Levemir FlexPen and Toujeo Solostar: Discar 6 weeks after opening |
Once the pen is in use, it need noy be kept in a fridge. Label each pen with a date on the sticker. |
| Brand new insulin | In the fridge at 2-8°C Do not store insulin in the freezer! |
Insulin should be removed from the fridge at least 30mins before injecting. Always check the expiry date before using insulin. |
Insulin is not to be checked in when travelling. Keep them in your hand-carry luggage.
Insulin site rotation
It is important to rotate your insulin injection sites in order to prevent lumps and hardened tissue from developing. Injecting into lumps or hardened tissue will affect the absorption of insulin and make it less effective.
Inject insulin into the fatty layer under your skin
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Move 2 fingers along from your last insulin injection site
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Insulin syringe (prepration and administration)
1. Wash and dry your hands. Remove insulin vial from fridge 30 minutes (if brand new and unopened) before injection.
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2. Roll the insulin bottle gently between your palms at least 10 times. This is particularly important if you are mixing insulin. Remember that premixed insulin is clody while short-acting or quick-acting insulin should be clear.
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3. Clean the top of the insulin vial with an alcohol swab.
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4. Draw the required amont of air (equal to the dosage of insuling required) into the syring by pulling the plunger down.
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5. Inject the required amount of air into the insulin vial.
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6. With the needle in the bottle, turn it upside down and withdraw the required amount of insulin into the syringe. Remove air bubles (if present) by flicking or tapping the syringe with your finger, expelling the bubbles.
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Wash and dry your hands. Roll the cloudy (intermediate-acting) bottle of insulin between your palms 10 times gently. Do not shake vigorously. Clean the top of the vial with an alcohol swab.

Draw the required amount of air (equal to the dosage of cloudy insulin) into the insulin syringe. Inject air into the cloudy insulin vial. Do not draw out any insulin, and remove the syringe and needle.

Using the same syringe and needle, draw the required amount of air (equal to the dosage of clear insulin) into the insulin syringe. Inject air into the clear insulin vial.

With the insulin syringe and needle attached, turn the clear insulin bottle upside down, with the needle bevel within the insulin, and withdraw the required amount of clear insulin into the syringe.
Then do the same with the cloudy insulin. Always withdraw clear insulin first before withdrawing cloudy insulin. Ensure the total dose of clear and cloudy insulin is correct. If overdrawn, discard and repeat.
Note that Mixtard insulin is already premixed and will therefore be cloudy. It requires just rolling of the vial between your palms 10 times gently to ensure it is well-mixed before use.
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Look out for the expiry date on the bottle
Write down the date and time of opening on the bottle
Do not use the insulin if it is discoloured, has lumps or flakes, or is frozen or heated
| 1. Check that you have the correct type of insulin vial. Check the expiry date from the date of opening. | 2. Check your dose of insulin prescribed and draw up the correct amount. |
3. Select and inspect the injection sites for any lumps or hardened areas, redness, swelling or scar tissue. Do not inject into these areas.
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4. Clean the injection site with an alcohol swab. |
| 5. Wait for the alcohol to dry. | 6. Gently lift a skinfold. Not everyone will need this step. Check with your healthcare provider.
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7. Position the needle at a 90-degree angle, perpendicular to the skin, and gently advance the needle into the skin.
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8. Inject the insulin by pushing the circular tip down gradually at a steady speed. |
| 9. Count for 10 seconds.9 Withdrawing the needle at the same angle it was inserted, release the skinfold. | 10. Discard the used insulin syringe in a punctureresistant sharps container and seal it before disposal.
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| Insulin | Storage | Remarks |
| Insulin in-use | At room temperature (max. Approximately 25-30C) For insulatard vial: Discard 4 weeks after opening For Mixtard vial: Discard 5 weeks after opening For Actrapid vial: Discard 6 weeks after opening Refer to manufacturer's guilde |
Once the vial is in use, it need not be kept in a fridge. Label each vial with a date on the sticker. |
| Brand new insulin | In the fridge at 2-8C Do not store insulin in the freezer! |
Insulin should be removed from the fridge at least 30mins before injecting. Always check the expiry date before using the insulin. |
Each insulin vial is for single patient use only. Insulin is not to be checked in when travelling. Keep them in your hand-carry luggage.
Ref: F26