Updated Guidelines For Consistently Effective Insulin Injections

About one year ago a conference convened in Rome to update insulin injection guidelines so people with diabetes can get optimal benefit from insulin use.

Results from the Forum for Injection Technique & Therapy Expert Recommendations, or FITTER, included insulin delivery suggestions garnered from 183 doctors, nurses, educators, and other conference attendees. The recommendations, recently published in Mayo Clinic Proceedings, includes these three important insulin tips:

  • 1. Use the shortest needle whatever your age, sex, weight, ethnicity, or BMI.
  • Ideally, a needle injects insulin into the layer of fatty tissue, or subcutaneous space, just under the skin’s surface. Numerous studies reveal that skin thickness does not, as once believed, vary much among individuals. Skin depth is generally consistent—running about 1 to 3 mm deep in 90 percent of us. This means the shortest needle lengths - 4mm for pens, 6mm for syringes - are long enough to inject insulin into our subcutaneous space.
  • Longer needles can potentially pass through the fatty layer and deliver insulin into muscle tissue, where absorption rates are less predictable. If you or your child use a longer needle discuss changing to a smaller one with your physician, or pharmacist.
  • 2. Identify lumps of fat under your skin, and avoid injecting into them.
  • An abnormal buildup of fat beneath the skin owed to repeated injections at the same site is called lipohypertrophy. This problematic fat tissue is firm, similar to a cluster of grapes, might be somewhat raised, and can be up to several inches in diameter. Because the lumps do not absorb insulin well, injecting into them may lead to glucose instability, higher A1C levels, and the need for increased insulin units.
  • Research indicates the incidence of lipohypertrophy is up to 50 percent for insulin users, and may be higher. Both patients and physicians should routinely check for this condition.
  • To help prevent fat accumulations, injection sites need to be continually rotated. Within injection zones, for instance, injections should be at least one adult finger width away from previous sites. Also, avoid reusing needles since this has been associated with lipohypertrophy development.
  • 3. Be certain that cloudy insulin is re-suspended, or properly dissolved.
  • Insulin can “fall out of solution” and appear cloudy when the molecular crystal structure alters. This makes injection concentrations variable, so using cloudy insulin can lead to unexpected highs or lows.
  • It’s important that users know how the insulin they use normally appears. Most of the common insulins (e.g., Novolg, Humalog, Lantus) are clear, but others such as NPH have a naturally cloudy look.
  • To re-suspend cloudy insulin, roll the vial or pen between the palms (full rotation circles), and repeatedly tip the container upside down and back—until the insulin looks as it should.

To learn more about these and other updated guidelines for insulin users, check out the informative, interactive FITTER website (link provided below).

Sources: Diatribe; Mayo Clinic Proceedings; Interactive FITTER site

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