Injecting Insulin Properly - Frequently Asked Questions

Lori Berard, RN, CDE, Diabetes Nurse Educator, goes over a variety of frequently asked questions when it comes to injecting insulin properly.

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Lori Berard, RN, CDE, Diabetes Nurse Educator, goes over a variety of frequently asked questions when it comes to injecting insulin properly.
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Featuring Lori Berard, RN, CDE, Diabetes Nurse Educator

Duration: 3 minutes, 33 seconds

We’re often asked why the FIT recommendations include 4-, 5- and 6-millimetre needles when we know that the shorter the better. Well, we have to do that because people across the country don’t necessarily have access to 4-millimetre needles, so we really want them to be using the shortest needle possible.

Then the other thing that comes up as a frequently asked question is if someone’s BMI is higher, does that mean they need the longer needle? And in fact, no. Research has shown that using a 4-millimetre needle in people with high BMI results in as good of glucose control as using a longer needle, so short is fine for all.

We continue to learn more about insulin injections all the time, and recently we’re starting to understand what force does to the injection. So what does that mean? If you jam your insulin injection into your tissue, you in fact increase your risk of hitting muscle. You also then squish your fat or subcutaneous tissue, and that can affect the way that you are absorbing your insulin. So, our recommendation to you is instead of jamming in your insulin, you want to think about sliding it in, like sliding it into butter.

One of the questions I’m asked very frequently is when should I split someone’s insulin dose? There’s evidence for the older human insulins that if you in fact split the insulin dose then you get a better time-action profile. The bigger the dose, the smaller the peak with human insulins.

So, that’s why we split NPH regular insulins. But, with the newer basal insulin analogs, there’s no evidence that you need to split the dose. In fact, you only split the dose as a function of the device. So, if the dose is higher than the amount that the device will deliver, then you need to split the dose.

Sometimes, you’re splitting the dose because it’s for comfort. The dose is big and it’s uncomfortable, so splitting it into two smaller injections can be more comfortable. And occasionally, under medical supervision, the dose is split to achieve specific glucose targets.

Most recently, we’ve seen the introduction of GLP-1 receptor agonists and insulin in a single delivery device. What that means is that we have to think about how we should be injecting these combination products.

So, first of all, insulin is part of that combination. So, good injection technique including proper rotation, and using a fresh needle each time. Second, is these devices often come with their own needles. So, we need to respect that, because often the size of the needle is related to the size of the molecule that’s being delivered.

If the needle looks like it might be too long for your body type, talk to your healthcare professional about how you can properly use that injection needle to deliver your dose. We continue to learn more about lipohypertrophy all the time, so some recent studies have helped us to understand how long it might take for lipohypertrophy to resolve. It’s about three to six months, in most cases, but everybody’s lipohypertrophy is different.

What’s important is that you remember a few things. Moving away from your areas of lipohypertrophy can mean that you will actually need less insulin. So, talk to your healthcare team about how to safely move into fresh tissue. The other thing is that you want to make sure that you’re having your area assessed, to make sure that there is no more lipohypertrophy before you start to use it again.

Injection technique matters, but it should be individualized, so make sure that you talk to your diabetes healthcare team about an injection technique and rotation pattern that works for you.

Presenter: Lori Berard, Nurse, Winnipeg, MB

Local Practitioners: Nurse

This content is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare professional with any questions you may have regarding a medical condition.