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 Based on the results, experts have crafted recommendations for
people who use insulin that touch on everything from what type of
needle to use to where the shot should be administered.
"Insulin injection has been assumed to be simple and require little
training, but that’s not the case," senior author Dr. Kenneth
Strauss wrote to Reuters Health in an email.
Insulin users "may have been injecting for years and yet have had
little or no training in correct technique," said Strauss, who is
medical director in Europe of the medical technology company BD.
In all 42 countries in the current study, many patients were
injecting improperly, "leading to worse glucose control, poorer
outcomes and higher costs," he said.
The researchers surveyed 13,289 people at 423 medical centers in
2014 and 2015. Ten percent of respondents said they had never
received formal injection instructions, and more than 60 percent
said their primary care providers hadn't reviewed instructions with
them recently.
Nearly 200 experts used the survey responses to help develop formal
recommendations.
For example, they recommend that patients use the shortest possible
needles, which "are safe, effective and less painful." A
4-millimeter (mm) needle is available on insulin "pens." The
shortest syringe needle is 6 mm.
"By using the shortest needles available, patients can avoid
intramuscular injections which can lead to (low blood sugar),
including the kind that can land them in the ER or cause an
accident," Strauss said.
Only half of the people surveyed were using the 4-mm or 6-mm
needles.
The authors also recommend ways to prevent small lumps known as
lipohypertrophy. These can develop when an injection site is used
over and over again, so patients need to rotate the sites. If lumps
do develop, injecting into those sites will adversely affect the way
the insulin is absorbed.
"We saw that ‘lipos’ . . . are at epidemic levels, with one out of
three injectors having them," Strauss said.
Lipohypertrophy was tied to a number of outcomes, including a higher
average blood sugar level, known as glycated hemoglobin, over the
past three months. High glycated hemoglobin is a sign of poor blood
sugar control and was also seen in people who don't properly rotate
their injection sites and who reuse needles.
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"By carefully rotating sites they will avoid ‘lipos’ and their
insulin will work better," Strauss said. "If everyone rotated
correctly ‘lipos’ would probably disappear, insulin consumption
would fall and we’d save millions as a consequence."
As for reusing needles, he said pen needles and syringes should be
used only once.
The experts also emphasize that the need for insulin can present
psychological challenges, which must be addressed in order for
people to manage their disease effectively.
And, they warn, insulin users need to be trained in the proper way
to dispose of needles and other sharps, because inappropriate
handling can pose a risk of infection.
"Those in the know that follow this kind of stuff, there is nothing
here surprising or dramatic," said Dr. Robert Gabbay, who is chief
medical officer and senior vice president of the Joslin Diabetes
Center in Boston. "But with that said, it’s the minority who are
prescribing insulin that know all these things."
Many primary care practices can refer patients to diabetes
educators. Gabbay, who was not involved in the new study, said
people who feel they need better education on how to inject insulin
would benefit from a session with these educators.
"If anything, this opens people eyes that there are tools our there
their provider may not be aware of and to seek out a diabetes
educator," he said.
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