Skin and subcutaneous thickness at injecting sites in children with diabetes: ultrasound findings and recommendations for giving injection

Presti, D. Lo; Ingegnosi, Carmela; Strauss, Kenneth

doi:10.1111/j.1399-5448.2012.00865.x

Cited by 75 publications

(82 citation statements)

References 33 publications

(69 reference statements)

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“…Ultrasound measurements have determined that 6% of all 6-mm 90°insertions will be intramuscular in adults 8 ; however, these measurements also included arms and thighs, which on average had 2-6 mm less subcutaneous tissue compared with the abdomen or buttocks. In a pediatric study 9 the mean -SD thickness of skin and subcutaneous tissue measured by ultrasound over the arm was 6.3 -1.9 mm, over the thigh was 7.5 -2.1, over the abdomen was 8.0 -3.4 mm, and over the buttocks was 8.1 -2.8 mm in children 14-17 years old. Using measurements inclusive of all sites, the researchers estimated that 35% of injections using a 6-mm needle would be intramuscular in 14-17 year olds and that 38% of injections would be intramuscular in 7-13 year olds.…”

Section: Figmentioning

confidence: 95%

Randomized Trial of Infusion Set Function: Steel Versus Teflon

Patel

Benasi²,

Ferrari³

et al. 2014

Diabetes Technology & Therapeutics

100

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Background: This study compared infusion set function for up to 1 week using either a Teflon Ò (Dupont Ô , Wilmington, DE) catheter or a steel catheter for insulin pump therapy in type 1 diabetes mellitus. Subjects and Methods: Twenty subjects participating in a randomized, open-labeled, crossover study were asked to wear two Quick-Set Ò and two Sure-T Ò infusion sets (both from Medtronic Minimed, Northridge, CA) until the infusion set failed or was worn for 1 week. All subjects wore a MiniMed continuous glucose monitoring system for the duration of the study. Results: One subject withdrew from the study. There were 38 weeks of Sure-T wear and 39 weeks of Quick-Set wear with no difference in the survival curves of the infusion sets. There was, however, a 15% initial failure rate with the Teflon infusion set. After 7 days, both types of infusion sets had a 64% failure rate. Overall, 30% failed because of hyperglycemia and a failed correction dose, 13% were removed for pain, 10% were pulled out by accident, 10% had erythema and/or induration of > 10 mm, 5% fell out because of loss of adhesion, and 4% were removed for infection. The main predictor of length of wear was the individual subject. There was no increase in hyperglycemia or daily insulin requirements when an infusion set was successfully used for 7 days (n = 25 of 77 weeks). Conclusions: We found no difference between steel and Teflon infusion sets in their function over 7 days, although 15% of Teflon sets failed because of kinking on insertion. The strongest predictor of prolonged 7-day infusion set function was the individual subject, not the type of infusion set.

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Section: Figmentioning

confidence: 95%

Randomized Trial of Infusion Set Function: Steel Versus Teflon

Patel

Benasi²,

Ferrari³

et al. 2014

Diabetes Technology & Therapeutics

100

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“…Previous research has indicated that ultrasound measured skin thickness (epidermis to dermis) can range from 1.53-1.97mm over a range of body areas in children aged 2-6 years with diabetes and increases with age [134]. The median unaffected skin site thickness in our current study was slightly below this range, however as the majority of children seen were under the age of two years, this fits within the projectory of increasing skin thickness with age.…”

Section: Discussionsupporting

confidence: 64%

A holistic exploration of paediatric partial thickness burn care in the outpatient setting

Kee¹

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“…Thin adult and children skin displays an average thickness of 2.23 mm in the arms, 1.87 mm in the thighs, 2.15 mm in the abdomen and 2.41 mm in the buttocks, both in [14][15][16]. As accidental intramuscular shots might cause hypoglycaemia [16][17][18][19][20], it is necessary to inject insulin beyond 2.5 mm without getting into the muscle.…”

Section: Commentsmentioning

confidence: 99%

“…As accidental intramuscular shots might cause hypoglycaemia [16][17][18][19][20], it is necessary to inject insulin beyond 2.5 mm without getting into the muscle. This is possible with short (4 mm) needles, which reduce the risk of intramuscular injection and do not increase insulin backflow even when inserted at 90°w ithout pinching the skin [17][18][19][20][21][22][23].…”

Section: Commentsmentioning

confidence: 99%

“…The latter is greater with syringes than with pens and therefore, when allowed to, people with DM choose pens. Nevertheless, it has been proven that, when a proper injection protocol is followed, both effectiveness and safety of the two devices are identical, allowing comparable metabolic control and complication risk [12,13].Thin adult and children skin displays an average thickness of 2.23 mm in the arms, 1.87 mm in the thighs, 2.15 mm in the abdomen and 2.41 mm in the buttocks, both in [14][15][16]. As accidental intramuscular shots might cause hypoglycaemia [16][17][18][19][20], it is necessary to inject insulin beyond 2.5 mm without getting into the muscle.…”

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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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Skin and subcutaneous thickness at injecting sites in children with diabetes: ultrasound findings and recommendations for giving injection

Cited by 75 publications

References 33 publications

Randomized Trial of Infusion Set Function: Steel Versus Teflon

Randomized Trial of Infusion Set Function: Steel Versus Teflon

A holistic exploration of paediatric partial thickness burn care in the outpatient setting

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

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