Guidance details proper insulin injection technique for people with diabetes
Key takeaways:
- A group of experts updated the FITTER insulin injection recommendations for the first time since 2016.
- The report includes new guidance on needle size and the angle at which injections should be performed.
Updated recommendations from an international group of diabetes experts aim to inform diabetes educators about best practices for insulin injections.
The Forum for Injection Technique and Therapy Expert Recommendations (FITTER) published updated guidance in Mayo Clinic Proceedings on how patients with diabetes should be administering insulin injections. The paper, known as “FITTER Forward,” was the first update to the group’s guidance since 2016.
David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, medical director of the Diabetes Research Institute at Mills-Peninsula Medical Center and lead author of the paper, discussed why it is crucial for health care professionals to educate and train people with diabetes on how to perform injections, especially if they are first starting to use insulin.
“We cannot take it for granted that a person who is not a health care professional is injecting themself properly,” Klonoff told Healio. “We assume they are doing it right, but once it a while, they are not. It’s about starting from the basics.”
Injection recommendations
The FITTER Forward recommendations are divided into four sections. After a section on how the physiology of insulin, devices and injection technique impacts the injection experience, researchers discussed how proper injection techniques can affect the efficacy of insulin therapy. For insulin injections, researchers recommend using a needle that is 4 mm in length with a 32 gauge width, a sharpness of 5 bevels and a contoured base.
“We came up with a recommendation that the optimal length of a needle is 4 mm,” Klonoff said. “Some people have used longer needles in the past, thinking the deeper it is, the better it is. But when you use a longer needle, there’s the risk it will reach the muscle.”
Insulin should also be injected at a 90° angle rather than a 45° angle, according to the report.
After an injection, the paper discusses the importance of proper needle disposal and why people with diabetes should not reuse needles.
The injection technique section also discusses insulin storage. The paper recommends storing unopened insulin in a refrigerator with a temperature of 36°F to 46°F.
One section of the recommendations discusses lipodystrophy disorders that can occur with improper insulin injections. A large focus was placed on lipohypertrophy, which is a swelling or enlargement of adipocytes. Klonoff said the condition, which can be diagnosed through ultrasound or by feeling bumps or abnormalities on the skin, can occur with poor injection technique or by injecting insulin in the same spot frequently instead of rotating to different sites on the body.
“[Lipohypertrophy] comes in different shapes, but if you can feel it, you already have a serious problem,” Klonoff said.
Patient education
The final section of the article examines how health care professionals play a vital role in educating people with diabetes about insulin injections. The section focuses on discussing the clinical, emotional and social needs of people with diabetes regarding their insulin regimen. The paper also emphasizes early education for people recently diagnosed with diabetes, giving people with diabetes their choice of insulin delivery devices and using visual tools during injection education.
Klonoff said it is also important for health care professionals to identify when a person with diabetes may be struggling with injections.
“If you see that a person’s glucose levels are unpredictable and they are having hypoglycemia, both of those are warning signs that they are not injecting properly,” Klonoff said.
Klonoff added that injection recommendations are not only applicable to people who use insulin.
“Insulin is not the only peptide drug that is used by people with diabetes, now that GLP-1 drugs and related incretin drugs are used,” Klonoff said. “There hasn’t been a FITTER-type article for [GLP-1s], but the principles we talked about would pertain to those drugs.”
One area the FITTER Forward recommendations do not touch on is alternate insulin delivery methods such as patch pumps, inhaled insulin or needle-free injectors. The authors wrote that a separate set of recommendations may be needed to cover alternate insulin delivery methods.
For more information:
David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, can be reached at dklonoff@diabetestechnology.org.
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