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Many diabetics who inject themselves with insulin are performing the task incorrectly according to one of the largest studies on diabetic patients.
These findings have prompted experts at the Mayo Clinic to issue new recommendations for proper insulin injection. The detailed recommendations, released online on Sept. 1, cover everything from the type of needle diabetics should use to where they should administer the shot.
In a recent Reuters Health article, Dr. Kenneth Strauss, one of the authors of the recommendations, noted that, "Insulin injection has been assumed to be simple and require little training, but that's not the case.”
In fact, Strauss says many diabetics in the study, which spanned 42 countries, have been “injecting for years and yet have had little or no training in correct technique." Poor technique leads to “worse glucose control, poorer outcomes and higher costs.”
As part of the survey, 13,289 diabetics were surveyed from 423 different medical centers between 2014 and 2015. Ten percent said they had never received formal training on injecting insulin. More than 60 percent said their primary care physician had not reviewed injection instructions with them recently.
Based on those survey results, a team of 200 experts developed a comprehensive set of recommendations. Three highlights include:
Short needles “are safe, effective and less painful." The shortest syringe needle is 6 mm while a 4-mm needle is available on insulin pens. "By using the shortest needles available, patients can avoid intramuscular injections which can lead to hypoglycemia, including the kind that can land them in the ER or cause an accident," Strauss said. Of those who responded to the survey, only 50 percent were using the smallest needles.
According to Srauss, lipohypertrophy was at epidemic levels among study participants. One in three participants suffered from it. Injecting into sites where lumps have developed adversely impacts the way insulin is absorbed. "By carefully rotating sites they will avoid 'lipos' and their insulin will work better. If everyone rotated correctly 'lipos' would probably disappear, insulin consumption would fall and we'd save millions as a consequence,” Strauss said.
Diabetics report several reasons for reusing needles, but the experts discourage this practice because it is associated with the development of lipohypertrophy.
The recommendations also emphasize the importance of addressing the psychological challenges that some diabetics face when they start using insulin. Failing to consider and treat these psychological challenges could adversely affect a patient’s ability to effectively manage diabetes.
Dr. Robert Gabbay, chief medical officer of the Joslin Diabetes Center in Boston, was not involved in the study or the writing of the recommendations. He says that while there is little in the recommendations that would surprise most providers, they do shine a light on the need to better educate patients who are managing diabetes.
"If anything, this opens people's eyes that there are tools our there their provider may not be aware of and to seek out a diabetes educator," Gabbay said.
To learn more, read the full list of recommendations.