Indian Injection Technique Study: Injecting Complications, Education, and the Health Care Professional

Kalra, Sanjay; Mithal, Ambrish; Sahay, Rakesh; John, Mathew; Unnikrishnan, Ambika Gopalakrishnan; Saboo, Banshi; Ghosh, Sujoy; Sanyal, Debmalya; Hirsch, Laurence; Vk, Gupta; Strauss, Kenneth

doi:10.1007/s13300-017-0244-9

Cited by 28 publications

(54 citation statements)

References 43 publications

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“…Extremely lean patients should be using a skin fold to inject even with a 4 mm and 5 mm needle. 8 In the present study 59% of patients used needle length of 6 mm, and a majority of 79% patients practiced injecting into the skinfold (Table 2 and 4).…”

Section: Discussionmentioning

confidence: 53%

“…7 This method of correct rotation of the injection site was practiced by nearly 3/4 th of the patients in the present study (Table 3), which is comparable with the study conducted by Kalra et al 8 Cleaning of injection site with sterile cotton swabs dipped in alcohol or water prior to injection is of utmost importance to ensure prevention of healthcare-associated infections. 8 In the present study, it was found that only 62% of the patients practiced cleansing of skin before injection (Table 4). Some longer-acting insulins contain a predetermined ratio of either crystalline insulin and solvent or crystalline insulin and rapid-acting soluble insulin.…”

Section: Discussionmentioning

confidence: 54%

“…Slow absorption occurs from buttocks. 8 Better glycemic control can be achieved by consistently rotating insulin injections within a set area. It also prevents the formation of scars, fatty deposits, and hard lumps.…”

Section: Discussionmentioning

confidence: 99%

“…LH retards insulin absorption significantly and can have an adverse effect on diabetes control. [5][6][7][8] It is evident from the previous studies that the awareness about insulin injection technique significantly influences adherence, outcome of treatment. These highlight the need to understand the existing knowledge, attitude and practice regarding insulin usage technique among diabetic patients.…”

mentioning

confidence: 99%

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Injection practices among the diabetes patients on insulin therapy in Chitradurga

Sindhu

Rashmi

Prashanth

et al. 2020

Int J Community Med Public Health

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Background: Diabetes mellitus has emerged as a global health problem. Insulin is the essential treatment modality for significant number of diabetic patients. Nearly 4 out of 10 patients with T2DM in India are using insulin, either alone or in combination with oral hypoglycemic drugs (OADs). The present study was conducted with the objectives to assess the knowledge and insulin injection practices, risk factors of sharps injury among diabetic patients who are on insulin treatment.Methods: Cross sectional study was conducted at a Basaveshwara hospital, Chitradurga, among diabetic patients on insulin treatment for minimum of past 6 months. Insulin injection technique questionnaire (ITQ) was administered to study participants and proforma was filled by interview technique.Results: 100 patients participated in the study. Syringe and needle device and 6 mm needle are most commonly used devices. 5-10 seconds was the most common duration of time (54%) for which the patients continued to keep the needle inserted in injection site after insulin injection. A 26% patients had lip hypertrophy at injection sites. Among households of the insulin users, a high percentage of children (41%) and house keeper/waste collectors (32%) were at risk of sharps injury. A majority of 55% of the insulin users reported that they didn’t have appropriate disposal containers for the used sharps.Conclusions: A 29% of participants did not practice proper rotation of injection site. Reuse of insulin needles was common practice. Pain/tenderness, lipo-hypertrophy and leakage of insulin after injection were noted at injection site. 10 seconds dwell time was reportedly practiced by only 23%, about half of patients skipped insulin injections and didn’t follow appropriate disposal of used sharps, thereby exposing both family members and waste collectors/handlers to higher risks of sharps injuries.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Injection practices among the diabetes patients on insulin therapy in Chitradurga

Sindhu

Rashmi

Prashanth

et al. 2020

Int J Community Med Public Health

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“…Patient was managed using talk, inspect and educate strategy followed by our endocrinology clinic considering the high prevalence of insulin-related lipohypertrophy in Indian patients 2. Readdressing correct injection technique is very important to curb lipohypertrophy and its consequences.…”

Section: Descriptionmentioning

confidence: 99%

Insulin-mediated lipohypertrophy: an uncommon cause of diabetic ketoacidosis

2017

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DescriptionA 15-year-old boy with a 3-year history of type 1 diabetes mellitus was referred to endocrinology clinic for the management of uncontrolled blood glucose levels. His present treatment plan comprised subcutaneous basal-bolus insulin regimen. He was taking regular insulin before the three major meals and insulin glargine at the bedtime. His body mass index (BMI) was 14.8 kg/m 2 and HbA1c level 14.9%, suggesting uncontrolled hyperglycaemia for a long time.On examination, he was found to have remarkably prominent bilateral lipohypertrophic areas on the lower abdomen (figure 1), large enough to be noticeable even through the clothing.His injection practices revealed that he was self-administering insulin over the abdomen with the syringe of needle size 6 mm, apparently leading to intramuscular injection in a thin-built person. 1 Furthermore, he was drawing his recommended dose of basal insulin with the 40 IU/mL syringe out of a vial of 100 IU/mL strength resulting into 2.5 times of the prescribed amount. However, the match between insulin syringe and strength was appropriate for the bolus doses.He was injecting in the area measured to be around 8.5×5.5 cm on either side of the lower abdomen approximating the size of a credit card. He preferred this area, as injections at this site were painless. In addition, he was not performing systematic site rotation within a quadrant of abdominal area by leaving a space of 1 cm for the subsequent injections. Moreover, one syringe was reportedly used on an average six times. Missing the doses of insulin along with the habit of injecting into lipohypertrophic lesions caused one episode of diabetic ketoacidosis requiring hospitalisation 2 weeks prior to this visit.Patient was managed using talk, inspect and educate strategy followed by our endocrinology clinic considering the high prevalence of insulin-related lipohypertrophy in Indian patients. 2Readdressing correct injection technique is very important to curb lipohypertrophy and its consequences. Therefore, the systematic rotation (figure 2) and practice of injections in larger area were explained to the patient. He was also directed to discontinue injections into lipohypertrophic lesions and advised to inject into the normal tissue. It was further recommended to reduce the dose of insulin, guided by self-monitoring of blood glucose, for avoiding hypoglycaemia while shifting to normal site. Patient was educated about the importance of adhering to Insulin-mediated lipohypertrophy: an uncommon cause of diabetic ketoacidosis Learning pointsCreate TIE (Talk, Inspect and Educate) with the patient ► Talk to the patients and their families regarding diabetes management to understand the ongoing challenges faced by them. ► Inspect the injection sites on regular basis for the early detection of lipohypertrophy. ► Educate the patients and their families about importance of proper insulin injection practice.

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Indian Injection Technique Study: Population Characteristics and Injection Practices

Kalra

Mithal²,

Sahay

et al. 2017

Diabetes Ther

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IntroductionIt was estimated that 3.2 million Indians with diabetes injected insulin in 2010, but little is known about the techniques used.MethodsIn 2015 we conducted an injection technique questionnaire (ITQ) survey throughout India involving 1011 patients. Indian values were compared with those from 41 other countries participating in the ITQ, known here as rest of world (ROW).ResultsMean HbA1c was 8.6. BMI values in India were 1.5–3 units lower than in ROW depending on patient group, meaning the risk of intramuscular (IM) injections is high in India. The mean total daily dose (TDD) of insulin was lower in every category of Indian patient than in ROW, perhaps reflecting the lower BMI. Needle reuse, whether with pens or syringes, is much higher in India than ROW and so is the number of times the needle is used. The majority (56.8%) of Indian insulin users performed only 2 injections/day as opposed to ROW where 45% of patients performed at least 4 injections/day. Indian patients inject insulin in the thighs more often than patients in ROW, a site where IM injections are more risky. Many patients do not have proper access to sharps containers or have other risk factors that could lead to blood-borne pathogen spread. More than 60% of used sharps in India go into the rubbish, with nearly 12% not even having the minimum protection of a cap.DiscussionThe shortest needles are very common in India; however, the level of needle reuse is high. Multiple daily injections therapy is not as common in India as ROW. More focus needs to be given to dwell times under the skin, reconstitution of cloudy insulins, skinfolds, and safe sharps disposal.

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Indian Injection Technique Study: Injecting Complications, Education, and the Health Care Professional

Cited by 28 publications

References 43 publications

Injection practices among the diabetes patients on insulin therapy in Chitradurga

Injection practices among the diabetes patients on insulin therapy in Chitradurga

Insulin-mediated lipohypertrophy: an uncommon cause of diabetic ketoacidosis

Indian Injection Technique Study: Population Characteristics and Injection Practices

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