The Safety of Injecting Insulin Through Clothing

Fleming, Doris R.; Jacober, Scott J.; Vandenberg, Melissa; Fitzgerald, James T.; Grunberger, George

doi:10.2337/diacare.20.3.244

Cited by 34 publications

(27 citation statements)

References 21 publications

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“…In general the recommended injection sites are the abdomen, thigh, buttock, and upper arm. 12,[14][15][16]41 The abdomen can be used within the following boundaries: approximately 1 cm above the symphysis pubis, approximately 1 cm below the lowest rib, approximately 1 cm away from the umbilicus, and laterally at the flanks. Patients can also use the upper third anterior lateral aspect of both thighs, the posterior lateral aspect of both upper buttocks and flanks, and the middle third posterior aspect of the upper arm.…”

Section: Discussionmentioning

confidence: 99%

Worldwide Injection Technique Questionnaire Study

Frid

Hirsch

Menchior

et al. 2016

Mayo Clinic Proceedings

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From February 1, 2014, through June 30, 2015, 13,289 insulin-injecting patients from 423 centers in 42 countries took part in one of the largest surveys ever performed in diabetes. The goal was to assess patient characteristics, as well as historical and practical aspects of their injection technique. Results show that 4- and 8-mm needle lengths are each used by nearly 30% of patients and 5- and 6-mm needles each by approximately 20%. Higher consumption of insulin (as measured by total daily dose) is associated with having lipohypertrophy (LH), injecting into LH, leakage from the injection site, and failing to reconstitute cloudy insulin. Glycated hemoglobin values are, on average, 0.5% higher in patients with LH and are significantly higher with incorrect rotation of sites and with needle reuse. Glycated hemoglobin values are lower in patients who distribute their injections over larger injection areas and whose sites are inspected routinely. The frequencies of unexpected hypoglycemia and glucose variability are significantly higher in those with LH, those injecting into LH, those who incorrectly rotate sites, and those who reuse needles. Needles associated with diabetes treatment are the most commonly used medical sharps in the world. However, correct disposal of sharps after use is critically suboptimal. Many used sharps end up in public trash and constitute a major accidental needlestick risk. Use of these data should stimulate renewed interest in and commitment to optimizing injection practices in patients with diabetes.

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Section: Discussionmentioning

confidence: 99%

Worldwide Injection Technique Questionnaire Study

Frid

Hirsch

Menchior

et al. 2016

Mayo Clinic Proceedings

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“…Recommended injection sites include the abdomen, lateral thigh, arms, and buttocks [34][35][36][37][38].…”

Section: Injection Site Carementioning

confidence: 99%

Optimal Insulin Delivery

Frid¹,

Hirsch²,

Strauss³

2019

Ultimate Guide to Insulin

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Insulin therapy is only effective if it is delivered into the right tissue in the right way. Exogenous insulin is intended for the subcutaneous (SC) tissue, not the muscle or skin. If delivered into the latter, its absorption (pharmacokinetics (PK)) and action (pharmacodynamics (PD)) are unpredictable, which often leads to poor glucose control. Correct insulin therapy begins with matching the insulin to the site used. Typically, four sites are used for insulin injection or infusion: the abdomen lateral to the umbilicus all the way to the flanks, the anterior lateral upper half of the thigh, the deltoid region of the arm, and the upper outer quadrant of the buttocks. Regular insulin and neutral protamine Hagedorn (NPH) are both absorbed more rapidly from the arm and abdominal sites and more slowly from the thigh and buttocks. The newer insulin analogs, both rapid-and slow-acting, do not appear to be influenced by the site used for injection. In order to avoid intramuscular (IM) injections, patients should use the shortest needles currently available (the 4-mm pen needle and the 6-mm syringe needle). Very young children should raise a skin fold and inject into it even when using the 4-mm needle. Giving injections with the 6-mm needle at a 45° angle converts this needle into the equivalent of the 4 mm. Injection sites should be rigorously rotated, with the new injection being approximately 1 cm from previous injections. This measure helps prevent the most common complication of injection therapy, lipohypertrophy (LH). Injecting into LH leads to unstable PK and PD and deregulated glucose control, manifested as unexpected hypoglycemia, glycemic variability, and elevated HbA1c values. Comprehensive insulin deliver recommendations have recently been published.

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“…There are no reports on the effect of mild hypothermic states or shivering on glucose metabolism or insulin pharmakinetics in healthy type 1 diabetics. To avoid the risk of delayed absorption due to cold skin and subsequent vasoconstriction, insulin can be safely injected through clothing (Fleming et al, 1997).…”

Section: Altitude Environment and Dm-1 Managementmentioning

confidence: 99%

Going High with Type 1 Diabetes

Leal

2005

High Altitude Medicine & Biology

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This review aims to identify the main issues facing a healthy and well-controlled type-1 diabetic mountaineer at high altitude. Most of the problems are self-managed by the diabetic climber although the risk of serious morbidity or even death remains. Given the scarce evidence on diabetes at altitude, an extensive search of the literature, including case reports and anecdotes was carried out to reach the recommendations.

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The Safety of Injecting Insulin Through Clothing

Abstract: It is safe and convenient to inject insulin through clothing.

Cited by 34 publications

References 21 publications

Worldwide Injection Technique Questionnaire Study

Worldwide Injection Technique Questionnaire Study

Optimal Insulin Delivery

Going High with Type 1 Diabetes

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