A 4-mm Needle Reduces the Risk of Intramuscular Injections Without Increasing Backflow to Skin Surface in Lean Diabetic Children and Adults

Birkebæk, Niels H; Solvig, Jan; Hansen, Bettina; Jørgensen, Christina Mørup; Smedegaard, J.; Christiansen, Jens Sandahl

doi:10.2337/dc08-0977

Cited by 64 publications

(63 citation statements)

References 3 publications

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Section: Commentsmentioning

confidence: 99%

“…Appropriate education on injection techniques is obviously essential, nevertheless it is often lacking [4], as shown by the high rate of skin lesions caused by incorrect injecting habits [11,36,[38][39][40][41][42][43][44][45][46][47][48][49][50].…”

Section: Educationmentioning

confidence: 99%

“…Education should also be regularly reinforced and healthcare professionals are expected to perform inspection and palpation interested sites on a regular, systematic basis in all subjects on injection therapy [26,36,48 This article is available from: http://medical-clinical-reviews.imedpub.com/archive.php especially in those facing repeated unexplained hypoglycaemic episodes [11]. Education should not be limited to treatment start, it should rather go on throughout the whole follow-up period with timely reinforcements [63], put special emphasis on the negative effects of getting into the muscle tissue or into altered skin areas.…”

Section: Educationmentioning

confidence: 99%

“…Also needle gauge (G) and sharpness are important factors in terms of patient acceptance and satisfaction [32][33][34][35]. 4 mm × 32G needles provide both obese and non-obese patients with comparable degrees of metabolic control as 5 mm × 31G and 8 mm × 31G needles but are perceived as less painful and better accepted [34,[36][37][38][39].Injecting insulin by shorter and thinner pen needles (4 mm and 32G) with triple bevels, in compliance with the UNI EN ISO 7864 standards, cause less pain and discomfort [14,36,[39][40] and ensure better therapy acceptance and adherence. In fact, the greater the outer diameter, the greater the resistance the needle has to face to penetrate the skin and, vice versa, the smaller the outer diameter, the less the feeling of discomfort at injection.…”

mentioning

confidence: 99%

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AMD-OSDI Consensus on Injection Techniques for People with Diabetes Mellitus

Gentile¹,

Grassi²,

Armentano³

et al. 2016

Med Clin Rev

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It goes without saying that all people with diabetes should be taught the best injection technique before starting insulin treatment. Nevertheless the extremely high rate of local injection-related skin reactions-i.e., lipodysthrophic lesions-described in literature, proves otherwise.We are hereby presenting a Consensus Document on Injecting Techniques which highlights 18 key points based on a thorough analysis of the available literature and ranked by "Level of evidence" and "Strength of recommendation" according to our National Guideline System.It is meant at providing all professionals involved in diabetes care with a practical guide on how to help patients on insulin perform well. Keywords: Insulin injections; Diabetes mellitus;Recommendations; Lipohypertrophy Was a Consensus Document on Injecting Techniques really needed?According to data from ISTAT (National Institute of Statistic) 2011 report [1] about 3 million people with diabetes mellitus (DM) are living in Italy nowadays, mostly in the South of our country, with a 5.1% prevalence of type 1 DM (T1DM). ARNO 2011 report, on the other side, witnessed in favour of a 10-year lasting ever increasing utilization of newer insulin preparations endowed with a more physiological pharmacokinetics profile, such as rapid-acting and basal analogues, as well as, of innovative therapeutic regimes [2]. In spite of technological progresses, and a general improvement in the quality of care, the 2012 AMD Annals [3] reported that only 22.2% T1DM and 43.8% T2DM patients reached HbA1c levels below 7% (53 mmol/mol), and T2DM patients above 9% (75 mmol/mol) accounted for 25.7% monitored people.Many factors related to insulin administration, storage and handling might contribute to poor metabolic control. Therefore, a major goal of health care teams is to educate patients and caregivers to the best possible injectable drug administration techniques and the most skilful utilization of related available devices.In order to let them reach that goal, we collected all available scientific evidences on this issue and organised it according to well-defined hierarchically distributed criteria targeted at patient's self-management/empowerment [4], and based on National Guideline System [5] with structured education on top. Our Consensus Document on Injecting Techniques represents in fact the final result of this strong clinical effort. Recommendations concerning injectable drug administrationA correct injection technique is essential for insulin and other subcutaneously administered medications to ensure optimal effects in people with diabetes mellitus (DM). It implies the ability to (i) choose the best needles, (ii) rotate injection sites regularly, (iii) handle and store insulin appropriately, (iv) insert needles correctly into the skin, (v) let pen needles inside the skin long enough to get the whole dose be absorbed and (vi) manipulate the skin before and after injection (Table 1) Insulin must be injected into intact subcutaneous tissue and intramuscular shots have to be av...

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Section: Commentsmentioning

confidence: 99%

Section: Educationmentioning

confidence: 99%

Section: Educationmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

AMD-OSDI Consensus on Injection Techniques for People with Diabetes Mellitus

Gentile¹,

Grassi²,

Armentano³

et al. 2016

Med Clin Rev

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show abstract

“…Insulin pens may therefore be preferable and help to facilitate adherence in the paediatric population as they were found to cause less fear and less injection pain than syringes in this study. Today, pen device needles are available in 4-6 mm lengths (30), while the shortest syringe needle is 8 mm (5). The pen needles are also thinner than syringe needles; the gauge of syringe needles is usually 30 (0.30 mm) (5), while pen needles designed for the paediatric population are available in 31 or 32 (0.25 or 0.23 mm) gauge (31).…”

Section: Use Of Insulin Pens In the Paediatric Populationmentioning

confidence: 99%

Insulin delivery by injection in children and adolescents with diabetes

Hanås¹,

Beaufort²,

Hoey³

et al. 2011

Pediatric Diabetes

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Indian Injection Technique Study: Population Characteristics and Injection Practices

Kalra

Mithal²,

Sahay

et al. 2017

Diabetes Ther

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IntroductionIt was estimated that 3.2 million Indians with diabetes injected insulin in 2010, but little is known about the techniques used.MethodsIn 2015 we conducted an injection technique questionnaire (ITQ) survey throughout India involving 1011 patients. Indian values were compared with those from 41 other countries participating in the ITQ, known here as rest of world (ROW).ResultsMean HbA1c was 8.6. BMI values in India were 1.5–3 units lower than in ROW depending on patient group, meaning the risk of intramuscular (IM) injections is high in India. The mean total daily dose (TDD) of insulin was lower in every category of Indian patient than in ROW, perhaps reflecting the lower BMI. Needle reuse, whether with pens or syringes, is much higher in India than ROW and so is the number of times the needle is used. The majority (56.8%) of Indian insulin users performed only 2 injections/day as opposed to ROW where 45% of patients performed at least 4 injections/day. Indian patients inject insulin in the thighs more often than patients in ROW, a site where IM injections are more risky. Many patients do not have proper access to sharps containers or have other risk factors that could lead to blood-borne pathogen spread. More than 60% of used sharps in India go into the rubbish, with nearly 12% not even having the minimum protection of a cap.DiscussionThe shortest needles are very common in India; however, the level of needle reuse is high. Multiple daily injections therapy is not as common in India as ROW. More focus needs to be given to dwell times under the skin, reconstitution of cloudy insulins, skinfolds, and safe sharps disposal.

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A 4-mm Needle Reduces the Risk of Intramuscular Injections Without Increasing Backflow to Skin Surface in Lean Diabetic Children and Adults

Cited by 64 publications

References 3 publications

AMD-OSDI Consensus on Injection Techniques for People with Diabetes Mellitus

AMD-OSDI Consensus on Injection Techniques for People with Diabetes Mellitus

Insulin delivery by injection in children and adolescents with diabetes

Indian Injection Technique Study: Population Characteristics and Injection Practices

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