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Diabetes Management
The Importance of Good Insulin Injection Practices in Diabetes Management
Richard Dolinar, MD
Clinical Endocrinologist, Arizona Endocrinology Center
Abstract
Time constraints are often significant when treating patients with diabetes with insulin. In such settings, focus is often placed on the type of insulin
the patient is taking, with an even greater emphasis placed on the amount. However, how much emphasis is placed on the practical aspects of insulin
use? Is the patient using proper injection techniques? Are the insulin syringes or pens being cared for correctly? Are needles being quietly re-used
without the medical staff’s knowledge? Are sharps being disposed of safely? Diabetes education regarding the proper use of insulin takes much time
and effort. Without it, however, the appropriate type of insulin at the correct dose might not necessarily give the intended outcome. Instead, marked
glycemic excursions could occur, leaving the goal of good diabetes control unachievable and the medical staff baffled.
Keywords
Diabetes, insulin, injection technique, insulin pens, insulin syringes, insulin needle re-use, patient education
Disclosure: Richard Dolinar, MD, is a member of the speakers’ bureaus of Amylin, Eli Lilly, and Takeda and a consultant for BD Medical and Pfizer.
Received: October 22, 2009 Accepted: December 2, 2009
Correspondence: Richard Dolinar, MD, Arizona Endocrinology Center, 5130 W. Thunderbird Road, Suite 1, Phoenix, AZ 85306. E: drdolinar@dolinar.org
When insulin-requiring patients with diabetes are seen in the clinic, administration, but also to review technique periodically, because over
there is usually a great emphasis placed on the type of insulin the time some patients may stray from recommended practices and develop
patient is taking and an even greater emphasis on the amount. However, their own techniques, which are less than optimal and may even be
how much emphasis is placed on the practical aspects of insulin use? harmful.
4
The following factors should be considered when teaching or
Which technique is the patient using to inject the insulin? Is he or she reviewing insulin injections with patients with diabetes.
injecting it correctly? What sites are being used? Are the insulin syringes
or pens being cared for properly? Are the needles being re-used? The Verification
patient might be on the right dose of the correct insulin, but if it is not Prior to the injection the patient must verify that the correct type and
being administered properly, optimal control will not be achieved. Thus, dose of insulin is being readied for injection. The insulin expiration date
there is a need to teach the patient and then periodically review the also needs to be checked at this time. The dates can vary significantly.
practical aspects of insulin injections. Good injection practices have The expiration date for insulin in pens or vials after being opened can be
evolved over many years. Syringes were first invented in the 15th very different depending on the type of insulin. The limiting factor is not
century in Italy, but their concept goes back to the time of Galen. It potency, as is commonly misunderstood, but rather sterility. After the
was not until 1844, however, that Francis Rynd developed the hollow recommended expiration date there is an increased possibility that
needle. In 1853 the hypodermic needle and syringe were invented the insulin is no longer sterile.
5
independently by the French surgeon Charles Gabriel Pravaz and the
Scottish physician Alexander Wood. They were first used to inject Storage and Shipping
morphine to relieve pain.
1
The modern-day disposable nylon and Prior to opening, insulin vials and pens should be refrigerated and not
polyethylene syringes first became available in the 1960s. They made frozen. Insulin received via mail order must be adequately protected
injections much more convenient. Needles and syringes have been used from extremes of temperature. If it becomes frozen, it should be
to inject all forms of medication. Today millions of patients inject discarded and never used. If insulin is shipped via mail order, one needs
themselves with insulin each day. Some use the insulin syringe and to confirm that it is being stored under the proper conditions.
6
After
others use the insulin pen, which became available in the 1980s.
2
Over opening, insulin vials can be either refrigerated or kept at room
three billion needles, syringes, and lancets are used each year in the US temperature. It is recommended, however, that insulin pens remain at
alone by more than eight million patients who have diabetes.
3
It is crucial room temperature once opened.
7,8
Pens should not be stored with the
that patients use them properly. Thus, there is a need in diabetes needles on. If the needle is left on, air can enter the insulin cartridge and
education not only to educate with regard to proper insulin affect dosage delivery. Insulin syringes can be drawn up and stored in
© TOUCH BRIEFINGS 2009 49
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