Insulin Injection Technique

About a year ago, an article titled “Improvement of Insulin Injection Technique” was published in The Diabetes Educator medical journal. It was written for healthcare professionals reviewing the medical literature related to issues that patients have with injecting insulin. I wanted to summarize some of this information to better help you, my readers and patients.

First we need to take a few steps back. All people with type 1 diabetes and many with type 2 diabetes require insulin to keep their blood sugars under control. This insulin has to be injected into the body somehow, using a vial and syringe, an insulin pen or an insulin pump. The insulin has to go into the fat layer under the skin, unlike, for example, a flu shot that goes into the muscle.

Lipohypertrophy

One of the biggest issues the article discusses is lipohypertrophy. Lipo-what?? Lipohypertrophy is a rubbery raised area under the skin caused by an accumulation of fat. It’s not dangerous or harmful per se, but continuing to use this area regularly for injections can cause a lot of different issues.

So what causes lipohypertrophy? The main cause is poor site rotation, meaning injecting insulin into the same area over and over again. Every injection should be at least 1-2 inches away from the last injection site. Each spot should be given some time to “heal” before being used again. If you are guilty of not rotating your sites, you are not alone. In a two-year survey started in 1998, only 38% of patients rotated sites each time they injected.

Reusing needles can also cause lipohypertrophy. It may be tempting to reuse needles to save some money, but it’s not worth it!!! Not only can this lead to contamination, infection and other issues, but it can cause those rubbery lipohypertrophy bumps as well. The reason is not totally understood, but in that 1998 survey mentioned previously, the reuse of needles increased the risk of lipohypertrophy by 31-44%.

Well, who really cares? Unless you’re a swimsuit model, most people won’t be noticing these bumps. However, there are some serious consequences to continuing to inject into these areas. Have you ever had any unexplained high blood sugar reading? These lipohypertrophy spots could be to blame. They’re associated with unexplained hyperglycemia and general unpredictability in blood sugars. They can decrease the absorption of insulin by up to 25%, making you need to use more insulin.

If you’re sitting here thinking, oh goodness, I need to start injecting in new places immediately, you will need to proceed with caution. If you’ve been guilty of jabbing yourself in the same place over and over, you may require less insulin when you start using some fresh real estate. Consider discussing decreasing your dose with you provider, or at least check your blood sugars more frequently for the next few days to see if your blood sugars are too low.

Priming

Another common issue is not priming insulin pens. Ideally, you should be priming before each injection. The purpose is remove air so you will receive the correct amount of insulin. This is done by holding the pen upright, dialing up to 2 units and depressing the injection button. You should see insulin come out of the needle. Refer to your manufacture instructions for specific priming information for your device.

Hold Down the Injection Button Long Enough

To make sure you’re actually getting the insulin you need from your pen, hold down the injection button for 10 seconds (I’ve read other sources stating 5 seconds- the large the dose the longer it should be kept in) after the button is fully depressed. The button should be depressed slowly- this is not a race! If you are using a vial and syringe, however, holding the needle in the skin after injection is not necessary.

Other Tips

• Do not share needles with others

• Do no keep an insulin pen needle on the pen after use- this lets air and bacteria flow through into the insulin

• Avoid injecting into stretch marks or scars

• Refrigerate, do not freeze, unused insulin

• Insulin that is currently being used should be stored at room temperature

• Once insulin has been opened and used, it should be thrown out after a month- see manufacture instructions for specific information on your product