Assessment of distance from skin surface to muscle for evaluation of the risk of inadvertent intramuscular insulin injection at potential injection sites among patients attending a tertiary care children's hospital in Sri Lanka–an observational study (original) (raw)
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Injection practices among the diabetes patients on insulin therapy in Chitradurga
International Journal Of Community Medicine And Public Health
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 ke...
Assessment of insulin injection techniques among diabetes patients in a tertiary care centre
A B S T R A C T Aims: The efficacy of insulin therapy in diabetes depends on proper storage and injection technique. The purpose of this study was to assess the practice of insulin administration among diabetes patients in a tertiary care center. Materials and methods: This observational study was done in Endocrinology department of a tertiary care center during April–June 2015. The consecutive patients using insulin for at least three months by either syringe or pen were recruited. All of them underwent a survey by the questionnaire which focused on key insulin injection parameters. Results: One hundred and sixty eight (74.67%) patients were storing insulin vials properly. The thigh was the most common site of insulin injection and 209(92.89%) study participants were rotating at the injection sites. Only 48.57% (34/70) subjects were mixing insulin properly before injection. The practice of hand washing and the cleaning of the injection site was practiced by 158(70%) & 171(76.44%) subjects respectively. One hundred and fifty six (69%) patients were injecting with the proper skin fold and 123 (55%) subjects were injecting insulin at 90 angle. The majority of patients (91%) were throwing the needle and syringes directly into the garbage and public drainage system. Conclusions: There was a significant gap between the insulin administration guidelines and current insulin injection practice. The diabetic education and counseling about proper insulin injection techniques should be provided to all diabetic subjects.
European Endocrinology, 2020
I ntroduction: Diabetes mellitus is highly prevalent in Bangladesh and insulin is often needed for diabetes control. We lack sufficient data on the insulin injection technique and injection-related complications. Methods: The Bangladesh Insulin Injection Technique Survey (BIITS) was conducted in 2018 in 18 centres throughout Bangladesh, involving 847 patients taking insulin for at least 6 months. All of the study subjects were interviewed using a structured questionnaire focusing on key insulin injection parameters. Results: The mean duration of insulin use by the study subjects was 3.84 (± 4.05) years and the mean daily dose of insulin was 41 (± 25) units. A total of 71.6% participants performed ≤2 injections/day and premixed insulins were the most commonly used insulins. Mean glycated haemoglobin (HbA1c) was 9.5% (± 2%). The proportion of syringe users and pen-device users was 68.1% and 31.9%, respectively. Most of the participants injected in the abdomen and rotated the injection site(s). The majority lifted the skinfold correctly and inserted the needle at a 90-degree angle, but their dwell times after injections were not adequate. A total of 9.2% of the subjects had injection-site lipohypertrophy (LH) and among them, 38.5% injected into the lesion. Patients with LH had higher HbA1c. Higher duration of insulin use (≥5 years), reusing needles more often (>10 times), and injecting at angles other than 90 degrees were independent predictors of LH. The incidences of hypoglycaemia (36.7%) and hyperglycaemia (67.4%) were very high, and subjects with LH had higher chances of both hypoglycaemia and hyperglycaemia. Though most (92.1%) of the patients received education about insulin injection initially, it was not repeated in the recent follow-up and was found to be ineffective. Conclusion: A huge gap between the insulin administration guidelines and current practice was observed in this study. Complications of insulin injections were also common. Healthcare providers should pay more attention to insulin education and re-evaluate injection practices from time to time.
… Objective: To determine the trends in insulin injection technique and associated complications in the local diabetic patients. Study Design: Cross-Sectional Descriptive study. Place and Duration of Study: This study was conducted in Department of Medicine at Fatima Memorial College & Hospital Lahore from 25th May 2015 to 25th October 2015. Patients and Method: Three hundred patients above 18 years of age who presented in outdoor and indoor department of the hospital, gave consent were enrolled. The data was collected through interview and relevant physical examination; data was analyzed by using SPSS 20.0 version. Results: 300 diabetics were enrolled; 108 (36%) male and 192 (64%) female. Mean age in males was 52.8±13.7 and in females was 52.2±11.8. Duration of insulin use was less than 5 years in 175 (58%) and 5 years or more in 125 (42%). Insulin syringe of 8 mm gauge was being used by 263 (87%). Abdomen was the injection site in 202 (67%); however, 279 (93%) rotated the injection site. The angle of injection was kept at 90 degrees by 254 (85%). The needle was reused for five or more times by 187 (52%) and 216 (72%) were self-injecting. Local complications were seen in 105 (35%); out of those pain was most commonly (35 %) reported. Among age groups significant association (p<0.05) was seen in site of insulin delivery, in age more than 60 years more injected in abdomen. In gender groups more males (83%) were self-injecting. Significant association (p<0.05) was seen in duration of insulin use and local complications. Majority, 126(72%) of those who were on insulin for less than 5 years did not have complications. Conclusion: Majority of our patients had adopted reasonable technique however repeated reinforcement can further improve appropriate insulin delivery, less wastage of insulin and better glycemic control with less chance of complications.
Clinical Diabetology
This consensus statement aimed to provide a simple and easily implementable practical educational guideline for healthcare professionals (HCPs) and patients regarding insulin injection practice in diabetes selfmanagement in the Indian setting. A group of experts analysed published data from guidelines, clinical trials and real world evidence to reach consensus recommendations on optimal insulin injection practices in terms of a) the injection sites (preparation of site of injection, choosing the injection site, site rotation), b) choice of device and storage of insulins, and c) safety precautions, sharp disposal practice and complications. Findings from Global and Indian arm of 2014-2015 ITQ Study were considered to emphasize a need for improved practice by HCPs covering all the vital topics essential to proper injection habits. The consensus statement provides a simple and easily implementable practical educational guideline for HCPs and patients to optimize insulin injection practices in accordance with recent advances in device manufacturing, newer research findings, and updated international guidelines as well as widespread concerns about neglected safety precautions such as single-patient use of pens and appropriate sharp disposal practices. (Clin
Journal of Diabetes Research
Introduction. Proper insulin injection practice is essential for better diabetic control. This study aims to assess the insulin injection practice of patients with diabetes. Materials and Methods. A cross-sectional study was conducted at Chitwan Medical College Teaching Hospital, Bharatpur, Nepal, from February 2017 to May 2017. Patients injecting insulin through insulin pens (n=43) for a minimum of 4 weeks were consecutively recruited. Patients’ baseline characteristics, current insulin injection technique, insulin transportation practice, complications of insulin injection, disposal practice of used needle, and acceptability of insulin were recorded. Descriptive statistics were performed using IBM-SPSS 20.0. Results. The insulin injection technique of patients and their relatives was inadequate. The majority of patients and their relatives (25, 58.1%) mentioned that they transport their insulin cartridge without maintaining cold chain. Thirteen patients (30.2%, n=43) reported comp...
Journal of Diabetes & Metabolic Disorders, 2020
Purpose The main aim of this study was to explore how participants were practicing insulin injections and assess its association with the insulin related-outcomes. Methods A hospital-based cross-sectional study was conducted among 176 youngsters with diabetes in Tikur Anbesa Specialized Hospital, Ethiopia. The inclusion criterion was the use of insulin treatment for a minimum of one year. Data about insulin injection practices was derived from participants' report. Descriptive statistics was presented using frequency distributions and percentages for categorical variables while measure of central tendencies and dispersion for continuous variables. Chisquare test was employed to test for the association between compared variables. Results Participants were asked on how frequent they practice the appropriate insulin injecting practices. Based on that, eliminating air bubbles from a syringe, lifting skin fold during an injection, inserting a needle deep enough in the subcutaneous tissue, inspecting injection sites and self-monitoring of blood glucose were frequently done practices in more than 80% of the participants. Besides, over half of the participants reported that they frequently practice; insulin vial inspection, physical exercise, inject 1-3 cm apart from previous site, and insert a needle at 45 0. Regarding insulin storage, more than half of them store opened insulin in the refrigerator, though it is advisable to store it at room temperature. Appropriate injection site rotation was reported by nearly one-third of the participants. Questions such as; gentle re-suspension of cloudy insulin, adjust insulin dose when necessary and change insulin syringe at every injection were reported by very few of the participants. Coming to glycemic control of our study subjects, 83% of them had HgbA1C of above 7.5% (non-optimal) and 31% reported at least one episode of hypoglycemia. Nonoptimal glycemic control was explained by poor injection site hygiene (p < 0.038) and infrequent inspection of injection sites (p < 0.049). Conclusion Compared to previous studies, this study came with higher proportion of participants who frequently practice the appropriate insulin injection practices. However, it is still important to educate patients on some crucial injecting practices.
international journal of endocrinology and metabolism, 2022
Background: The appropriate insulin injection skill is essential for optimal blood sugar control in diabetic patients. However, the art of insulin injection is still not well understood in numerous medical centers. Objectives: This study was designed to determine the association between appropriate insulin injection and blood glucose control in patients with type 2 diabetes in Yazd, Iran. Methods: This cross-sectional study was conducted on 301 type 2 diabetes who referred to Diabetes Research Center in Yazd within August 2020 to February 2021. Based on simple random sampling, the subjects with inclusion criteria, such as age >18 years, using an insulin pen for at least 3 months, and self-injection, were selected. The insulin injection technique was evaluated by a 13-item researcher-made questionnaire. The total score of this questionnaire was 30, and its validity and reliability were confirmed. The data were analyzed using SPSS software (version 20). Results: The mean age of the participants was 59.83 ± 10.26 years, and 60.1% had primary school or less education. Most participants (87%) used a needle more than five times, and almost half of them (53.5%) did not rotate the injection sites properly. The patients who reported pain during injection had statically lower injection scores than others (17.90 vs. 19.38, P = 0.001). There was a significant negative correlation between insulin injection score with fasting blood sugar (β =-0.232, P < 0.001), two-hour postprandial glucose (β =-0.164, P = 0.005), and hemoglobin A1c (HbA1c) level (β =-0.263, P < 0.001) in patients. Conclusions: None of the patients in this study fully followed the principles of a proper injection, which can lead to pain during injection, lipohypertrophy, hyperglycemia, and increased HbA1c levels.
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2015
To assess the prevalence of fear of needles and its effect on glycemic control in children with type 1 diabetes mellitus (T1DM) on multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Patients aged 6 to 17 years with T1DM on MDI or CSII (n = 150) were enrolled. All caregivers and patients aged ≥11 years completed a "Diabetes Fear of Injecting and Self-testing Questionnaire" (D-FISQ). Needle phobia was defined as a score ≥6 for fear of self-testing (FST), fear of injections (FI), and fear of infusion-site changes (FISC). Positive FST scores were noted in 10.0% and positive FI or FISC scores in 32.7% (caregivers' responses). Patients aged 6 to 10 years on CSII had greater fear (FISC) than those on MDI (FI) (P = .010). FST was inversely related to the number of daily blood sugar checks (P = .003). Patients with positive scores for FI/FISC or FST had significantly higher glycated hemoglobin (HbA1c) levels than those without. An inverse associ...
Indian journal of endocrinology and metabolism
Health-care professionals in India frequently manage injection or infusion therapies in persons with diabetes (PWD). Patients taking insulin should know the importance of proper needle size, correct injection process, complication avoidance, and all other aspects of injection technique from the first visit onward. To assist health-care practitioners in their clinical practice, Forum for Injection Technique and Therapy Expert Recommendations, India, has updated the practical advice and made it more comprehensive evidence-based best practice information. Adherence to these updated recommendations, learning, and translating them into clinical practice should lead to effective therapies, improved outcomes, and lower costs for PWD.