September 2, 2011

From Joslin – Proper Way to Inject Insulin

This has been an interesting topic for several years, but along the way, many people have dropped the ball and it is just now that some organizations are realizing that there are better ways to inject insulin. According to a workshop in Athens (TITAN) in September 2009 there is a proper way to inject insulin.

Why it took so many organizations so long to evaluate this report is still a mystery. Why health practitioners have taken so long to adopt the methods in this report make me wonder about the knowledge of many health practitioners. True, there was little consensus prior to this report and most like to use evidence-based guidelines to support what they tell their patients.

At least Joslin Diabetes Center has recognized that there is evidence to be looked at and is in the process of reviewing their own procedures in light of the report and consensus reports available. They report the following from an injection survey: 21% of patients admitted injecting into the same site for a whole day or even for a few days, 50% of patients had symptoms suggestive of lipohypertrophy (a lump under the skin caused by accumulation of extra fat at the site of many subcutaneous injections of insulin), and 35% of patients using NPH don’t remix it prior to use. These findings are important as lipohypertrophy can also cause changes in the action or timing of insulin delivery.

Another factor that should help most people with the potential new standards is the use of shorter needles instead of the half an inch needles most of us are used to. The new recommendations remove the classic pinch most of us have been taught as the shorter needles will not require this. It is also not necessary to use an angle shot unless you are still needing to use the pinch method in areas with little fat and muscle near the surface. Straight-in is now the preferred injection angle except as last mentioned.

This does not affect me, but for anyone using a pen for injecting insulin, please read Joslin's findings for proper use of a pen. A few of their recommendations are something to adapt to and I have even been taught to do with my needles. Never remove the pen needle from the injection site immediately. They recommend counting to 10 before withdrawing the pen to prevent back leakage which can reduce the amount of insulin available.

This blog should be read by everyone that injects insulin and for anyone on oral medications that is considering the switch to insulin. Expect to see or read more as other healthcare organizations adopt new standards.

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