Many PWD Inject Insulin Incorrectly

This study is a shock to me! I am going to need to review how I inject my insulin. Yes, I know I do some of this incorrectly as I am using a syringe that has a needle of one-half an inch in length and that is not the recommended length. The problem is this is the only size of needle the supplier has available.

Based on the results of the study, experts have crafted recommendations for people who use insulin that touch on everything from what type of needle to use to where the shot should be administered. The study and recommendations were published online September 1st in Mayo Clinic Proceedings.

"Insulin injection has been assumed to be simple and require little training, but that's not the case," senior author Dr. Kenneth Strauss wrote to Reuters Health in an email.

Insulin users "may have been injecting for years and yet have had little or no training in correct technique," said Strauss, who is medical director in Europe of the medical technology company BD. In all 42 countries in the current study, many patients were injecting improperly, "leading to worse glucose control, poorer outcomes and higher costs," he said.

The researchers surveyed 13,289 people at 423 medical centers in 2014 and 2015. Ten percent of respondents said they had never received formal injection instructions, and more than 60 percent said their primary care providers had not reviewed instructions with them recently.

Nearly 200 experts used the survey responses to help develop formal recommendations. For example, they recommend that patients use the shortest possible needles, which "are safe, effective and less painful." A 4-mm needle is available on insulin "pens." The shortest syringe needle is 6 mm.

"By using the shortest needles available, patients can avoid intramuscular injections which can lead to hypoglycemia, including the kind that can land them in the ER or cause an accident," Strauss said. Only half of the people surveyed were using the 4-mm or 6-mm needles.

The authors also recommend ways to prevent lipohypertrophy. These can develop when an injection site is used repeatedly, so patients need to rotate the sites. If lumps do develop, injecting into those sites will adversely affect the way the insulin is absorbed. "We saw that 'lipos' . . . are at epidemic levels, with one out of three injectors having them," Strauss said. Lipohypertrophy was tied to a number of outcomes, including a higher average glycated hemoglobin level over the past three months.

"By carefully rotating sites they will avoid 'lipos' and their insulin will work better," Strauss said. "If everyone rotated correctly 'lipos' would probably disappear, insulin consumption would fall and we'd save millions as a consequence."

Many primary care practices can refer patients to diabetes educators. Gabbay, who was not involved in the new study, said people who feel they need better education on how to inject insulin would benefit from a session with these educators.

"If anything, this opens people's eyes that there are tools out there their provider may not be aware of and to seek out a diabetes educator," he said.