Give insulin injections Insulin Syringes:
A large international survey of more than 13,000 patients treated with insulin shows the frequency of poor injection techniques and the use of needles that are too long. these poor practices are likely to lead to the occurrence of lipodystrophies. these abnormalities of the subcutaneous tissue can promote the occurrence of hypoglycaemia.
This shows the interest of the work of a group of experts, from three continents, who relied on nearly 300 publications to update recommendations on good injection practices.
We have extracted some data useful in daily practice for patients and caregivers.
What needle length?
The 4 mm needles are long enough to reach the subcutaneous tissues, with a minimal risk of intramuscular injection (likely to modify the absorption of insulin) and this regardless of age and possible overweight. They are therefore recommended
Fold or not?
The needle must be inserted perpendicular to the skin but, in children under 6 years old and in very thin adults, a fold can be made.
Which injection areas?
The following sites are recommended: abdomen, thighs, buttocks, upper arms. In pregnant women, the abdomen can be used, with a fold from the second trimester. Never inject into a site where there are lipodystrophies or skin lesions.
Disinfect or not?
As a general rule, it is not necessary to disinfect. Experts recommend disinfecting if the injection site is not clean and when the injection is performed in a hospital setting or in an EHPAD (Accommodation Establishment for Dependent Elderly People).
What rotation of injection sites?
The rotation of injection sites must be systematic; insulin should not be injected within 1 cm of the previous sites. The healthcare professional should provide patients with an appropriate rotation scheme. For insulin analogues, the sites are all equivalent in terms of resorption.
Reusing needles?
Experts advise against the reuse of needles which could be associated with an increased risk of lipodystrophy. share a pen with another patient? This practice is formally contraindicated due to the risk of infection.
All these good practices constitute the “hard core” of therapeutic education on insulin injection. Learning to detect lipodystrophies is also part of it; when an insulin suspension (cloudy when solutions are clear), such as NPH or "mixes" is used, homogenization (by shaking the pen) and resorption differences, depending on the site of infection, are also part of this hard core.
