Insulin injection errors ubiquitous in adults with diabetes
medwireNews: Canadian researchers have identified at least one insulin injection technique error in all people with insulin-dependent diabetes who were surveyed for a study.
They found an average of 3.5 errors of insulin injection technique among the 230 people they surveyed, with only 5% of the study participants making just one error and 2% making seven, with excessive injection force being the most common.
When shown a set of images depicting how the skin might appear when the person with diabetes pressed the button on the insulin pen, over 30% opted for the image where the skin was significantly indented, and 76% chose an image that showed greater than optimal force.
“Proper technique indicates the needle hub should be visible and to avoid indenting the skin when injecting to reduce the risk of intramuscular injection,” note Lori Berard (Winnipeg, Manitoba, Canada) and study co-authors.
Another common problem was that only 39% of study participants said they left the needle in their skin for the minimum 10 seconds recommended to ensure full dose delivery and prevent leakage. Around 40% left the needle in for 5 seconds, and about 20% said they removed it quickly.
Of concern, 40% of participants reused their needles. For a small minority, this was for five or more injections.
“Pen needles should be used only once to reduce the risk of lipohypertrophy, needle breakage in the skin, infection, inaccurate dosing, and clogging of the needles,” write Berard and team in Diabetes Therapy.
Two-thirds (66%) of the study participants reported using the optimal needle length, of 4 mm, but a minority used longer needles, and many did not know their needle length. Nearly two-thirds (64%) injected into an area smaller than the postcard-sized area recommended to optimize site rotation and reduce the risk of lipohypertrophy.
Of the 33% of people who had developed lumps and bumps (ie, potential lipohypertrophy) in their injection area, 37% injected insulin into these sites.
Finally, 55% of the study participants were performing a skin lift, but 69% of these people were using 4 or 5 mm needles, rendering it unnecessary.
The participants, who were aged between 19 and 87 years, were recruited to the study by 24 physicians, the majority of whom were experienced and felt confident discussing insulin injection technique with their patients.
The researchers cite studies showing significant reductions in glycated hemoglobin following insulin injection technique education, showing that “even though patients may commit numerous insulin injection errors, these patient errors can be rectified with the proper assessment and education, thus producing a positive, clinically relevant outcome.”
But they stress the need for re-training, potentially every 8–12 months, which “helps ensure that bad habits are halted and keeps the patient up to date with the latest guideline recommendations.”
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