Subcutaneous insulin injection technique

The aim of this article is to update general nurses’ knowledge of insulin injections. The importance of choosing the optimal injection site for the prescribed insulin regimen and matching the site with the needle length and injection technique is discussed. The appropriate storage of injection devices between use, resuspension of cloudy insulins, and safe disposal of pen needles are also highlighted. After reading this article you should be able to: ■ Provide evidence-based, individualised advice on the optimal injection sites and pen needle sizes for each patient and his or her prescribed insulin type and regimen. ■ Explain what causes lipohypertrophy and lipoatrophy and how to prevent both. ■ Update your colleagues and patients on recommended insulin injection techniques. ■ Re-educate healthcare professionals and insulin users on the importance of resuspending cloudy insulin and the long-term adverse effects of needle re-use. Insulin therapy was initiated during the 1920s and since then scientists have focused on producing newer and improved types of insulin in an attempt to mimic the physiological action of human insulin in a patient with diabetes. More recently, it has been proposed that the way the injection is performed is as important to good glycaemic control as the type and dose of insulin given (Partanen and Rissanen 2000, Strauss 2002a). The techniques used for insulin injection contribute to variability and fluctuations in blood glucose control. In the UK, about 580,000 people inject insulin every day and many have been doing so for years or decades (Diabetes UK 2001). More patients now prefer multiple daily injections using a variety of devices, with the global trend in recent years away from syringe use and towards pens (NovoCare News 2000). Large-scale studies have been carried out on optimal insulin regimens but little attention has been given to what the ideal needle length might be, how to pick injection sites appropriately, and how to avoid problems in injection areas. Use of modern ultrasound and magnetic resonance imaging (MRI) technology has revealed misconceptions about current injection practices (Strauss 2002a). Nurses play a crucial role as instructors in insulin administration and need to update and reassess their knowledge of relevant contemporary research findings.