Golden rules of insulin injection technique


New recommendations for insulin delivery have just been published in the Mayo Clinic Proceedings on the back of research showing that many individuals with diabetes are not delivering insulin correctly.

The recommendations are a result of an international workshop known as the Forum for Injection Technique & Therapy Expert Recommendations (FITTER) which brought together 183 diabetes experts from 54 countries to analyse and address the key findings from the largest ever international injection technique survey.

New recommendations: what you need to know

The paper details the evidence base for insulin delivery and includes an appendix outlining the “Golden Rules” of insulin delivery. These include:

  • Correct choice of injection/infusion site and technique to ensure insulin is deposited into healthy subcutaneous fat tissue, avoiding the intradermal and intramuscular spaces as well as scars and LH.
  • Choosing the right needle length – the guidelines recommend using the shortest available needles (4mm pen needles or 6mm syringes) for all individuals, regardless of age, BMI, gender or ethnicity.
  • The importance of routine injection and infusion site rotation.
  • The need for all patients who inject or infuse insulin to have their sites checked at every regular visit to their diabetes team, or at least annually, and to be taught to self-inspect sites and be able to distinguish healthy from unhealthy tissue.
  • The importance of more frequent monitoring and the likely need for a reduction in insulin doses (often 20% or more) when someone moves away from injecting/infusing into sites affected by LH.
  • The need for diabetes healthcare professionals to be skilled in identifying psychological issues that impact insulin delivery, and the need to have a range of therapeutic behavioural skills to minimise the psychological distress and the impact of insulin therapy.
  • Recommendations for the safe disposal of sharps and reducing needlestick injuries.

While the evidence-base is detailed, the “golden rules” provide an easy-to-read summary of the main recommendations for busy health professionals.

“These rules are meant as a clear and simple road map for nurses, educators, and patients”, the authors write. “If the rules are followed, nearly all of the new recommendations will be implemented”.

Accompanying the recommendations are two additional papers outlining the key findings from the 2015 Injection Technique Questionnaire (ITQ) Survey, and highlighting the need for better education around correct insulin delivery techniques.

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