If you have been talking about getting started on insulin with your doctor, or if taking insulin is new to you, you may have questions or concerns.

The following guide will help you understand the types of insulin, options for taking insulin, how and where to inject insulin, and insulin care and storage.

Insulin pens

Your pen comes with an instruction book. Please review it to understand how your pen works, how to load the cartridge and how to prepare your pen for an insulin injection.

Mixing insulin

Insulin that is cloudy (NPH, premixed) needs to be mixed before using. The pen should be rolled ten times, tipped ten times and checked for a milky-white consistency.

Check insulin flow (prime)

Attach pen needle. Dial up two units and, with pen tip facing upwards, push the dosing button. If no stream of insulin appears, repeat with another two units.

Giving your injection

After you have checked the insulin flow, dial up the dose of insulin to be taken. Insert pen tip into skin at a 90º angle. Push the dosing button until you see ‘0’. Count 10 seconds before removing the needle from your skin to ensure you receive the full dose. With longer needles (≥ 8mm), you may need to gently lift the skin before injection.

Insulin Injections area

Insulin injection sites
Site Pros Cons

Abdomen (tummy)

  • Stay 2 inches (5 cm) away from your belly button
Easy to reach; insulin absorbs fast and consistently None
Buttock and thigh Slower absorption rate than from abdomen and arm sites Slower absorption; absorption can be affected by exercise
Outer arm After abdomen, arm provides the next fastest absorption rate Harder to reach for self-injections

NOTE: It is really important to change (rotate) where you give yourself insulin to prevent fatty lumps from forming since these can affect how your body absorbs insulin. For example, you can move from one side of your abdomen to the other side, and you can also move your injection site to a different location within each side of your abdomen.

Avoid a two-inch area around the belly button as well as scar tissue.

Insulin types

(How quickly it starts working)
(What it is most effective)
(How long it works)
Timing of injection
(When should it be given)
Bolus insulins
Rapid acting analogues
  • Apidra/Humalog/NovoRapid
10-15 min 1-2 hours 3-5 hours Given with 1 or more meals per day. To be given 0-15 minutes before or after meals.
  • Humulin-R/Toronto
30 min 2-3 hours 6.5 hours Given with one or more meals per day. Should be injected 30-45 minutes before the start of the meal.
Basal insulins
  • Humulin-N/NPH
1-3 hours 5-8 hours Up to 18 hours Often started once daily at bedtime. May be given once or twice daily. Not given at any time specific to meals.
Long-acting analogues
  • Lantus
  • Levemir
90 min Not applicable

Lantus: Up to 24 hours

Levemir: 16-24 hours

Often started once daily at bedtime. Insulin detemir (Levemir) may be given once or twice daily. Not given at any time specific to meals.
Premixed insulins
Premixed regular insulin
  • Humulin 30/70 and Novolin ge 30/70, 40/60, 50/50
Varies according to types of insulin Contains a fixed ratio of insulin (% of rapid-acting or short-acting insulin to % of intermediate-acting insulin): See above for information about peak actions based on insulin contained Given with one or more meals per day. Should be injected 30-45 minutes before the start of the meal.
Premixed insulin analogues
  • NovoMix 30 and Humalog Mix 25, Mix 50
Varies according to types of insulin Given with one or more meals per day. Should be injected 0-15 minutes before or after meals.

Insulin care and storage

Unopened insulin should be stored in the fridge between 2ºC and 8ºC. Opened insulin can be stored at room temperature for up to one month. Insulin detemir (Levemir) is an exception; it is safe at room temperature for 42 days. Keep all insulins away from direct heat and light. Discard insulin that has been frozen or exposed to temperatures greater than 30ºC. Do not use insulin after its expiry date.

Diabetes identification

You should always wear idenfication, such as a bracelet or necklace, to identify that you have diabetes. Identification bracelets, such as MedicAlert®, can be purchased at pharmacies and jewellery stores. Always carry identification in your wallet or purse that provides information about your diabetes.

Checking your blood sugars

Below is a schedule you can use to help you organize your blood sugar information.

Breakfast Lunch Supper Bedtime Night
Before After Before After Before After
SMBG pattern*

*SMBG = Self-monitoring of blood glucose

Proper use of pen tips (needles)

Use pen tips only once; they are thin and can become bent or broken if re-used. Reusing pen tips can make the injection more painful. Leaving pen tips on the cartridge may cause leaking or allow air into the cartridge which may affect the concentration of the insulin.

Safe sharps disposal

Pen tips and lancets should be disposed of in a sharps container. Check with your local pharmacy. Many pharmacies supply safe, puncture-proof containers. When the container is full, it is returned to the pharmacy in exchange for a new container. Sharps otherwise should be disposed of in accordance with local regulations.

Diabetes Driving Guidelines

Prevention of hypoglycemia for all insulin-treated drivers

  • Measure your blood glucose level immediately before and at least every 4 hours during long drives. Always carry blood glucose monitoring equipment and treatment for hypoglycemia within easy reach (e.g. attached to the visor).
  • You should not drive when your blood glucose level is less than 4.0 mmol/L. You should not begin to drive without having some carbohydrate-containing food when your blood glucose level is between 4.0 – 5.0 mmol/L.
  • Stop and treat yourself as soon as hypoglycemia and/or impaired driving is suspected. You should not drive for at least 45 – 60 minutes after effective treatment of mild to moderate hypoglycemia (i.e. blood glucose level 2.5 – 4.0 mmol/L).

Professional Drivers must

  • Carry supplies when you are driving:
  • A blood glucose monitor
  • A source of readily available, rapidly absorbable carbohydrate
  • Test your blood glucose 1 hour before starting to drive and approximately every 4 hours while driving
  • Stop driving if your glucose level falls below 6.0 mmol/L and do not resume driving until your glucose level has risen to 6.0 mmol/L or higher following food ingestion

Each province has its own rules regarding glucose control and being able to drive.

I want to apply for a commercial licence. Can I drive in Canada? In the United States?
Canadians with diabetes who are using insulin can apply for a commercial licence. Motor vehicle licensing authorities require a greater level of medical fitness for drivers operating passenger vehicles (buses/commercial vans), trucks, and emergency vehicles. Commercial drivers spend more time driving and are often under more adverse conditions than private drivers.

Canadians with diabetes who are using insulin can be licensed to drive a commercial vehicle in Canada. The Canada/US Medical Reciprocity Agreement (effective March 1999) recognizes the similarity between Canadian and American medical standards and provides for reciprocal arrangements on medical fitness requirements for Canadian and American drivers of commercial vehicles.

However, Canadian commercial drivers who have diabetes requiring insulin, have monocular vision, are hearing impaired, or have epilepsy requiring anticonvulsive medication are not permitted to drive in the United States.

What is Diabetes Canada’s position on diabetes and driving and licensing?
Diabetes Canada believes people with diabetes should be assessed for a driver’s licence on an individual basis.


Adapted from Canadian Diabetes Association’s Clinical Practice Guidelines for Diabetes and Private and Commercial Driving. Canadian Journal of Diabetes. 2003;27(2):128-140.

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