Defining the Ideal Injection Techniques When Using 5-mm Needles in Children and Adults

Abstract

OBJECTIVEWe aimed to establish the ideal injection techniques using 5-mm needles to reliably inject insulin into the subcutaneous fat in both children and adults and to quantify the associated pain and leakage of the test medium.RESEARCH DESIGN AND METHODSA total of 259 subjects (122 children/adolescents and 137 adults) were injected with sterile air corresponding to 20 IU insulin (200 μl) with 32-G 5-mm needles at 90° or 45°, in the abdomen and thigh, and with or without a pinched skin fold. Injection depth was assessed via ultrasonography. Subjects rated pain on a visual analog scale. Test medium injections into the abdomen and thigh (0.2–0.6 ml) were also administered to assess injection leakage.RESULTSAmong children, 5.5% of injections were intramuscular (IM) and 0.5% were intradermal, while in adults, the incidence was 1.3 and 0.6%, respectively. The frequency of IM injections was greater in boys and negligible among adult women. Subcutaneous fat thickness was the primary predictor of the likelihood of IM injections (P < 0.001). A third of all patients reported experiencing no pain during insulin injection, with children/adolescents experiencing considerably more discomfort than adults. Some leakage of medium was observed, but was unrelated to injection volume and was generally minimal.CONCLUSIONS5-mm needles are reliably inserted into subcutaneous fat in both adults and children. These needles were associated with reduced pain and minimal leakage. We recommend an angled injection with a pinched skin fold for children, while in adults, the technique should be left to patient preference.

Needle with a Novel Attachment Versus Conventional Screw-Thread Needles: A Preference and Usability Test Among Adults with Diabetes and Impaired Manual Dexterity

“…[43][44][45][46][47][48][49] Indeed, 5-mm  32-gauge needles such as NovoTwist have previously been found to be much less painful than longer needles for the administration of insulin in children and adults with a minimum risk of intramuscular injection and without major backflow compared to 6-mm needles. 18 Although pain perception was not assessed in this test, the reduced injection pain from 5-mm NovoTwist needles and reduced risk of intra-muscular injection may further enhance the perception of safety with NovoTwist in a real-life setting.…”

“…Previous studies have indicated that the diameter and design of the needle play an important role in reducing injection pain and needle anxiety in subcutaneous insulin delivery and in improving patient satisfaction. [18][19][20] In one study, significantly more patients preferred the shorter 31-gauge  6-mm needles compared with a longer 29-gauge  12.7-mm needles. 21 Another study reported that 58% of patients had a preference for 32-gauge  6-mm needles compared with 30-gauge  8-mm needles, whereas 26% patients preferred the longer needle.…”

The Subcutis Ultrasound Map of Type 1 Diabetic Children Improves the Diagnosis of Local Dystrophies and Insulin Injection Technique

“…The dystrophies can be clinically diagnosed as either hypertrophic, nodular or atrophic. The SC remodelling is a local consequence of some factors such: very frequently injected areas, duration of treatment, inappropriate injecting technique, needle's quality, physicochemical properties of insulins or individual response as suggested by Lo Presti (2012), Hofman (2007Hofman ( , 2010, Bierkebaek (1998), Wallymahmed (2004) and Hildebrandt (1991). Lipodistrophies were noticed when the administration route was either a portable pump or boluses as Rademecker (2007) had found.…”

AMD-OSDI Consensus on Injection Techniques for People with Diabetes Mellitus

“…In the transition from a longer needle to a shorter one, there might be differences in insulin absorption, therefore monitoring blood Subcutaneous tissue thickness varies significantly depending on sex, body mass index, age, ethnicity, diabetes type, morphology of the diabetic individual, as well as, on pressure exerted during injection [8,11,14]. The risk of intramuscular injections depends on that all and has been estimated to be 15.3% with 8 mm, 5.7% with 6 mm and 0.4% with 4 mm needles [14,[26][27][28].…”

“…In the transition from a longer needle to a shorter one, there might be differences in insulin absorption, therefore monitoring blood Subcutaneous tissue thickness varies significantly depending on sex, body mass index, age, ethnicity, diabetes type, morphology of the diabetic individual, as well as, on pressure exerted during injection [8,11,14]. The risk of intramuscular injections depends on that all and has been estimated to be 15.3% with 8 mm, 5.7% with 6 mm and 0.4% with 4 mm needles [14,[26][27][28].Injection site rotation within large surfaces, needle disposal after each shot and 45° angle pinch technique utilization with needles >6 mm are essential factors to ensure optimal insulin absorption and prevent skin injury [11,15,22,[29][30][31][32][33][34].With the advent of insulin analogues, absorption varies much less both between and within individuals and is therefore more predictable and easier to handle by the patient [30]. However, despite technological advances allowing newer and newer insulin analogue availability, certain absorption/ action affecting factors still remain, such as exercise, counterregulatory hormones, high dosage, incorrectly mixed preparations or even the habit to pull out needles from the skin too early after pen pistons reaching their end stroke positions [29,30].…”