The Indian Council of Medical Research (ICMR) on Wednesday issued a set of recent guidelines for Type 1 Diabetes (*1*), together with insulin storage and mixing, and instructions for needle and injection websites. The recent guidelines come because the Covid-19 pandemic has disproportionately affected folks with diabetes, exposing them to a excessive threat for extreme sickness and mortality. “All kids and adults with sort 1 diabetes (T1DM) require insulin as quickly as they’re recognized and repeatedly thereafter all through life,” the medical physique stated in its up to date guidelines.

Here is what the new guidelines say:

ICMR guidelines for storage of insulin

> At the time of buying the insulin, the expiry date must be checked and it must be ensured that there are not any clumps or discolouration of the insulin.

> The unopened insulin vial or cartridge must be stored on the fridge shelf for long-term use. They shouldn’t be uncovered to direct daylight or by no means be frozen.

> Once opened, the insulin vial will be stored at room temperature for as much as a month in cooler climates. In hotter climates, insulin will be saved on the fridge shelf. At room temperature – 25 levels Celsius – insulin will lose lower than one per cent of its efficiency over a month, whereas at larger temperatures there will likely be a higher lack of efficiency.

> The newest guidelines say that insulin pens ought to by no means be saved with the needles connected since air could also be drawn in.

Guidelines on insulin needles

The size of needles beneficial by ICMR for injecting insulin in most youngsters and adults is 4 to 6 millimetres. The insulin must be injected at an angle of 45 to 60 levels as a substitute of 90 levels to keep away from the chance of intramuscular injection.

Guidelines on insulin injection site

> The forearm and calves ought to by no means be used for insulin injections.


> In normal, the identical area must be used for injection at totally different instances of the day. However, the precise websites must be modified day by day by shifting 0.5-1.0 inches from the earlier site.

> Injections within the stomach end in sooner absorption and are much less affected by train, therefore the site is appropriate for injecting faster-acting insulin preparations.

ICMR guidelines on insulin mixing

Regular and NPH (Neutral Protamine Hagedorn) insulin will be combined for use in a syringe (split-mixed routine). For this objective, common insulin must be drawn first adopted by NPH insulin.

> Allow insulin vials to succeed in room temperature and verify there are not any clumps or particles.

> Turn the NPH bottle on its aspect and gently roll it between the palms. Do not shake vigorously as it could harm the vial.

> Clean the highest of the vial with an alcohol swab. Take the NPH insulin vial and inject air equal to the required dose. Do not draw insulin but. Remove the needle from the vial.

> Take the vial with common insulin, clear the highest with alcohol and inject an air of an quantity equal to the common insulin dose.

> With the needle nonetheless within the common vial, flip the vial the other way up and pull the plunger to fill the syringe with the specified dose. Remove any air bubbles from the vial.

> Re-insert the needle into the vial of NPH insulin, slowly draw the correct quantity of insulin and take away the needle from the vial. The syringe is prepared for injecting

Insulin strengths

In India, human common and NPH insulin can be found in strengths of 40 models/ml and 100 models/ml in vials. All insulin (common, NPH, analogues) in pen cartridges have a energy of 100 models/ml.