Life Health

Half of diabetics not injecting properly

Marilyn Linton. (DAVE ABEL/QMI Agency)

By Marilyn Linton, QMI Agency

(Craig Glover/QMI AGENCY)

(Craig Glover/QMI AGENCY)

If you have diabetes – and two and a half million Canadians do – read this before you take your next shot. Because according to a 2010 international injection technique survey of 4,000 people, many people “on the needle” to control their diabetes could benefit from being re-taught how to do it more safely, more efficiently – in short, better.

“Most of us believe that the people we look after are doing what we originally taught them to do,” says Lori Berard, a Winnipeg nurse/diabetes educator who chairs the Canadian arm of the Forum for Injection Techniques (FIT), which aims to re-teach needle usage to people who inject themselves. “But what this international survey found was that there was a lot of overuse of injection sites among people who inject themselves daily.”

Most Canadians with Type 1 diabetes and some with Type 2 manage their condition through insulin or incretin mimetic (a type of hormone) injections. The survey found that people are injecting into skin areas that are not healthy, that they are not holding their needles in long enough or using needles that are the wrong length, and that they are hitting muscle instead of subcutaneous tissue.

“People have a favorite injection spot, say, on the right side of their abdomen, and they use that same spot over and over again,” says Carole Ann Maloney, clinical education specialist at BD Canada, a medtech company that produces insulin needles. “As a result they end up with lipohypertrophy or fatty scar tissue that forms under the top layer of the skin.”

These rubbery lesions can result in a decrease in the rate of insulin absorption and inconsistent insulin absorption. The international survey found that 47% of participants had experienced lipohypertrophy. Patients are creatures of habit and often do not rotate their injection sites, explains Lori Bedard. “And as educators, some of us have also lost that discussion around how healthy are your sites.”

People with diabetes can be injecting themselves up to four times per day, adds Carole Ann Maloney. Proper injection techniques into healthy injection sites may help reduce insulin requirements by up to 30%. Yet almost a third of people living with diabetes can’t recall ever having their injection sites checked, which is why the FIT forum group wants people to ask their doctors to check their sites at least once a year.

How and where you inject is as important as what you inject. For example, the needle should be given into subcutaneous tissue, not muscle; insulin is absorbed fastest from the abdomen, slowest in the buttock; and you shouldn’t inject through clothing. More tips on techniques can be found at fitfordiabetes.com. Support is also available on Facebook.com/diabetesinnovations.

The fact is, diabetes needle technology today makes injection a no-brainer. But Lori Berard says that it’s important for people to really pay attention to what they are doing: “We want them to use the right needle length, to inject at the proper angle, and to perform a bit of a skin lift. If you don’t angle your injection properly and use too long a needle, you will hit that muscle.”

Berard also urges her patients not to reuse their needles: “I understand that some people want to save money or find it convenient to reuse especially if they are injecting four times a day. But we still don’t want people to reuse needles because a blunt needle will damage tissue.”

Re-teaching is important, says Berard – adding that doctors, nurse practitioners or pharmacists can help Canadians to get it right. It’s estimated that close to 50% of people are not injecting insulin properly. “When we start someone on insulin we have to cover so many things, so it’s very hard to retain all the information.”

 


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