New Insulin Delivery Recommendations

Frid, Anders; Kreugel, Gillian; Grassi, Giorgio; Halimi, Serge; Hicks, Debbie; Hirsch, Laurence; Smith, Mike; Wellhoener, Regine; Bode, Bruce W.; Hirsch, Irl B.; Kalra, Sanjay; Ji, Linong; Strauss, Kenneth

doi:10.1016/j.mayocp.2016.06.010

Cited by 234 publications

(324 citation statements)

References 214 publications

(150 reference statements)

Supporting

Mentioning

278

Contrasting

Unclassified

Order By: Relevance

“…Those who always injected into an area of LH decreased with increasing age from 40.8 (G1) to 14.9 (G2) to 8.8% (G3). More than one-half of pediatric patients in every group reported having injection pain [5], with the younger the patients, the higher the percentage of those who reported pain, and the more frequently it was reported (Table 4). …”

Section: Resultsmentioning

confidence: 99%

“…Based on these findings, the New Insulin Delivery Recommendations state that the 4-mm pen needle ‘should be considered the safest pen needles for adults and children regardless of age, gender, ethnicity and BMI’ [5]. The Recommendations also provide advice on site care, injection site rotation, prevention of complications, alleviation of pain, disposal of used sharps, and the appropriate psychological approach to managing pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…Of these patients, 898 (6.8%) were in the pediatric age range (≤ 18 years). The findings from the ITQ were used to formulate and publish the New Insulin Delivery Recommendations on a worldwide basis [5]. The New Recommendations include sections relevant to pediatric patients, based on published studies on insulin injections in children going back many years.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

et al. 2018

Self Cite

View full text Add to dashboard Cite

IntroductionThe 2015 Insulin Injection Technique Questionnaire survey involving 13,289 patients included 898 (6.8%) patients in the pediatric age range (≤ 18 years).MethodsThe younger patients included in the questionnaire survey were grouped according to age: Group 1 (G1), 0–6 years, n = 85; Group 2(G2), 7–13, n = 423; Group 3 (G3), 14–18, n = 390. The injection technique was evaluated by means of a questionnaire and nurse assessment.ResultsNurses found lipohypertrophy at injection sites in 41.3, 45.2, and 47.3% of patients in G1, G2, and G3, respectively. Unexpected hypoglycemia was common, ranging from 23.8 to 48.1% of patients, and glucose variability was even more common (61.0% in G1, 45.9% in G2, and 52.5% in G3); both conditions were associated with lipohypertrophy. While increasing numbers of patients were using the recommended 4-mm needles, large percentages still used longer ones (33.3% in G1, 45.9% in G2, and 61.5% in G3). The reuse of needles was also common, ranging from 21.1 to 32.5% in the three age groups. Excessive reuse, defined as using a single needle more than five times, was reported by 9.4–21.8% of patients in the three age group. The percentages of patients who had not received any injection training in the last 12 months ranged from 21.2 to 26.8% in the three groups.ConclusionImplications of our study are as follows: (1) pediatric patients should use 4-mm pen needles or 6-mm syringes (inserted at a 45° angle); (2) patients aged ≤ 6 years should always inject into a raised skin fold regardless of which device is used; (3) all patients should rotate sites and use needles only once to avoid lipohypertrophy.FundingBecton–Dickinson (BD) diabetes care.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…Comprehensive evidencebased guidelines are available to inform the correct injection technique. 10 Insulin technique counseling needs to be incorporated in every clinic visit.…”

Section: Methods Of Injectionmentioning

confidence: 99%

Insulin—Five ‘M’s that Matter

Kalra¹

2017

US Endocrinology

Self Cite

View full text Add to dashboard Cite

This editorial describes a simple and useful checklist that facilitates timely and appropriate insulin initiation and usage in type 2 diabetes. The ‘five Ms’ (5Ms) mnemonic list facilitates timely insulin use by breaking the process down into five ‘M’s: match, motivate, method, monitor, and modify. The 5Ms approach conveys the need to match the patient to the appropriate insulin regime, preparation, and delivery device; to motivate the patient to accept insulin through a process of informed, shared decision making; to ensure the correct method of insulin delivery by teaching injection technique; to monitor therapy by both biomedical (glycemic control, metabolic benefit) and patient reported outcomes (quality of life); and to modify therapeutic strategy, as and when needed. This concept can be used as a teaching tool, a clinical aid, and a practice audit.

show abstract

“…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.…”

Section: Descriptionmentioning

confidence: 99%

Insulin-mediated lipohypertrophy: an uncommon cause of diabetic ketoacidosis

2017

View full text Add to dashboard Cite

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.

show abstract

New Insulin Delivery Recommendations

Cited by 234 publications

References 214 publications

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

Insulin—Five ‘M’s that Matter

Insulin-mediated lipohypertrophy: an uncommon cause of diabetic ketoacidosis

Contact Info

Product

Resources

About