Did you know that how medication is injected, where medication is injected and what medication is injected with is as important as the medication itself? I think when we talk about diabetes management, we do not always think about the how, where and what as often as we should.
Most recently, awareness has been raised internationally regarding the injection techniques of people treating their diabetes with injectable medications such as insulin and the more recently available GLP-1 analogues (known as Byetta® and Victoza®). Published in late 2010, a survey of over 4300 patients world wide, but sadly not in Canada, asked people living with diabetes and their health care providers about injection technique (how the injection was prepared and given, as well as disposal of sharps and things such as site rotation and the areas used to inject). This survey has really opened the eyes of health care professionals and reminded them to start checking injection sites and how injections are given.
In response to this survey and an international set of recommendations, a group of Canadian health care providers - including myself - got together to write a set of recommendations for the Canadian diabetes population. We wanted to make sure we were providing clear instructions to health care professionals regarding techniques to avoid intramuscular injection and ensure a healthy injection site. We wanted to ensure that the assessment, care and education of people living with diabetes is up to date and accurate.
What does all this mean to you? Often when people with diabetes have been injecting insulin for a long time, they have a certain way of doing things that is familiar and they may never have discussed how they prepare or give their injection for a very long time - if ever. They may be using the same needles they got when they first started insulin. Yet now we have finer, shorter needles to deliver insulin that may be more comfortable and be less likely to result in injecting insulin into a muscle.
Maybe you are the person who gives the injection as a caregiver or loved one. Are you rotating the site with every injection and making sure that the injection area is healthy? When insulin is given too often in the same site, an area of fatty scar tissue develops. This is not to be confused with normal fat tissue, as the fatty scar tissue does not properly absorb the insulin. These areas can also develop if you are not changing insulin needles as recommended and if you are moving the needle under the skin during the injection. The best example of this occurs when someone is on more insulin than the pen dials up to. It is a very common practice to inject, hold the needle under the skin and then dial the rest of the needed insulin. This should be stopped – the shaky hand can cause the tissue under the skin to be damaged.
Other things to think about include how much fat tissue is available under the skin to inject into. Sometimes you need to gently lift the skin to make sure that when the injection is given, it goes into fatty tissue and not muscle.
Maybe the insulin used is cloudy. Has it been tipped and rolled 10 times and checked to make sure it has mixed properly? Last but not least, make sure skin is clean and dispose of the sharps properly.
Practical information like this is found within the FIT Recommendations for healthcare professionals and it has also been adapted for people using insulin to understand at this link - under Canada!! You can also visit the FIT section on this website.
Really importantly, when you see the healthcare professional next time, ask them to check the injection sites. You can have a conversation about making sure medication is prepared properly, the site is healthy, the needle length is right, the injection technique provides an injection into the fatty tissue, the needle is held under the skin for an appropriate length of time and that the sharps are disposed of properly. This will help to make sure the medication is delivered effectively.