Published on 15 December 2016

An updated set of recommendations injecting insulin has been published, including findings from the largest injection technique survey of its kind.

The new insulin delivery recommendations for healthcare professionals caring for people with diabetes who are using insulin were recently published in the Mayo Clinic Proceedings journal.

Recent studies reported that many people with diabetes were using insulin incorrectly and not getting the maximum benefit from the life-saving medication.

Injecting insulin incorrectly can lead to health complications linked to diabetes

The article highlighted that correct injection and infusion technique was needed to make sure the effect of taking insulin was consistent - and could be as important as the medication or diet and activity.

The injection technique recommendations were made following the Forum for Injection Technique & Therapy Expert Recommendations (FITTER) international workshop – that included 183 diabetes experts from 54 countries and took place in Rome last year.

Two of the papers published in Mayo Clinic Proceedings address the key findings from this injection technique survey and a third paper presents the new insulin delivery recommendations, intended to help shape local and regional injection guidelines around the world.

The new FITTER recommendations for healthcare professionals include:

  • Use the shortest available pen needle (currently 4mm) or syringe needle (currently 6mm) for all injecting patients, regardless of age, sex or body size.
    • The shortest needle length is less painful, has higher patient acceptance and gives comparable glucose control.
    • By contrast, excessively long needles increase the risk of intramuscular injections, which can accelerate insulin uptake and action, increasing glucose variability and risk of hypoglycemia.
  • Correct rotation of injection sites can reduce the frequency of lipohypertrophy (fatty lumps on the surface of the skin - a common side effect of insulin injections). Such reductions should improve glycaemic (blood sugar) control and clinical outcomes, reduce insulin consumption and thereby lower healthcare costs.
  • Limit use of pen needles and syringes to one-time, as reusing needles is not an optimal injection practice because they are no longer sterile after use.

Insulin injection pen.

Dr Kenneth Strauss, co-author and Medical Director at Becton Dickinson, said: “FITTER and these publications set new standards for insulin delivery. Tools are embedded in these publications, which will allow patients and professionals to quickly translate them into everyday practice. If these recommendations become routine practice, we should soon see the improved outcomes that come from optimised insulin delivery.”

The survey on insulin injection technique found that many people taking insulin were using needles that are longer and thicker than recommended, and were reusing the needles frequently.

One-third of those taking insulin had lipohypertrophy, or lipos - linked with incorrect rotation of injection sites and also problematic with insulin infused via pumps.

The survey also found that if people injected into lipos, the absorption of insulin was blunted and highly variable – which could cause people to react by injecting more insulin, which puts them at risk of unexpected glucose swings and dangerous hypoglycemia (low blood sugar levels).

Despite using more insulin, people with lipos had worse blood sugar control, increasing their risk of developing eye, kidney and nerve complications.

Dr Laurence Hirsch, co-author and worldwide vice president of Medical Affairs for BD Diabetes Care. “These new recommendations will help health care professionals and people with diabetes who take insulin to better manage their treatment.”

Dr Anders H Frid, lead author and Diabetologist at the Skane University Hospital, Malmö in Sweden said: “For more than 30 years, I have been studying injection sites, injection technique and insulin absorption. It is a wonderful accomplishment to now have comprehensive and evidence-based recommendations around proper needle use and good injection practices published in a major journal for health care professionals and people with diabetes around the world to access.”

Read the “Golden Rules” developed for Proper Injection Technique for Adults and Children; Treating and Preventing Lipohypertrophy, Psychological Issues around Insulin Delivery and Needle stick Injuries and Sharps Disposal at:  

Read the report in Mayo Clinic Proceedings
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