A large number of patients with Diabetes require Insulin and often develop Insulin deficiency. However, they simply need to take it with the help of a syringe or pen devices. This Insulin then keeps glucose or sugar in normal range, keeping a person healthy.

Unfortunately, in countries like India, Pakistan, Sri Lanka, Bangladesh etc where paramedic support is poor, Insulin treatment becomes more difficult. Most doctors prescribe Insulin but they have no time to train patients about taking Insulin shots. Very often an untrained person trains patients.

And so Insulin prick-related problems are common in these countries. Problems like lipohypertrophy, injection site marks, infections are more common Indian and Asian patients.

Injection sites and angles
One of the most important aspects of Insulin injection technique is injection site. Insulin should reach subcutaneous tissue, that is, the layer of fat below skin. So areas like abdomen [except around navel], outer side of thigh and arms are considered as good sites. Unfortunately, many patients still inject it into the forearm or calf region, which is not correct.

Apart from site, the next important thing is angle of injection. Earlier, longer needles of 12 mm were available and hence it was recommended to inject at 45-degree angle so as to avoid intramuscularly injection, particularly in individuals with a thin built. But nowadays, shorter needles of 5 to 6 mm are available. With these needles, it is best to inject Insulin at 90-degree angle.

Injection site rotation is yet another important concept. If Insulin is injected at same point then that area of skin becomes more fatty and this is called lipohypertrophy. Insulin injected into this area is absorbed slowly and erratically and this makes sugar control difficult. Since the prick in this area is painless, the patient prefers it but later on gets in trouble due to fluctuations in glucose levels. Thus, it is very important that a patient should inject at different points and should go on rotating injection sites.

Insulin absorption
Another focus should be on the site of injection and rate of Insulin absorption. Most of the studies show that absorption is most rapid at abdomen. Hence it is important that morning Insulin or short acting Insulin can be injected into abdomen while night insulin can be injected into thigh. Alternatively, all morning shots can be taken on abdomen while evening shots on thigh so as to make insulin absorption more consistent. This would avoid unexpected variation in insulin level due to injection site change.

Reusing needles

How often to reuse needle- is also an important issue. Though needles are made for a single use, in India, most of the patients are reusing needles due to cost factor.
Ideally a patient should not reuse a needle, but still if one has to, then consider a few points. Better not to reuse a needle more than thrice or four times. Do not boil it. In fact, do not touch the needle. Maintain personal hygiene and wash hands before injecting insulin.

A thumb rule

When a patient reuses a needle, its tip becomes blunt and it can cause injury to skin and create a point for bacterial entry, leading to infection. Thus, as a rule of thumb, if a needle hurts, do not reuse it.

These aspects of Insulin therapy are presented in an easy-to-understand slide show on Online Class section of diabeteshormone.com