3 common problems with insulin injection, how to solve them?

• Abnormal insulin absorption;

• poor blood sugar control, fluctuations in blood sugar, unexplained hypoglycemia;

• Bleeding, bruising, pain
  .
  

In order to ensure that insulin is injected into the subcutaneous layer, patients should check the injection site before each injection, in general, obese patients do not need to pinch the abdomen, while emaciated patients need to pinch the skin; Women's thighs do not need to be pinched and injected, and men's thighs need to be pinched and injected; There is no need for pinching injections in the buttocks
.
If insulin is injected with a long insulin pen needle or insulin syringe, it must be pinched or injected at a 45-degree angle
.

Figure 1 Injection sites for patients of different body types

Figure 2 Correct kneading method

At the same time, the correct selection of the right length of needle is crucial, shorter needles are safer and often better tolerated by patients
.
The short needle ensures that the drug is injected into the subcutaneous tissue and significantly reduces the risk of
hypoglycemia caused by injection into the muscle layer.

Figure 3 Percentage of risk of intramuscular injection due to needle injection of different lengths

Problem 2: The injection site is not rotated

Failure to rotate the injection site correctly is an independent risk factor for the development of subcutaneous lipoplasia, and studies have found that subcutaneous lipoplasia is found in nearly two-thirds of patients, 98% of whom have either the injection site or the rotation method is incorrect
.
Some patients even deliberately choose the subcutaneous fat hyperplasia site for injection
because the injection is not painful.

Compared with injection into normal subcutaneous adipose tissue, insulin injection into the site of subcutaneous fat hyperplasia will significantly reduce insulin absorption, increase blood glucose fluctuations, significantly reduce insulin peak concentration by 34%, the effect of insulin on blood glucose decreased by 27% in the first 4 hours, and the postprandial blood glucose concentration increased significantly, increasing by 58% 2-5 hours after injection, which has significant negative effects
on insulin absorption and postprandial blood sugar control.

In fact, most patients who inject insulin for a long time do not know that the injection site should be rotated during injection, and it is more likely that they will not rotate the site correctly or are psychologically unwilling to rotate the site
.

For psychological problems, health care providers can adjust
appropriately by frequently emphasizing to patients the short- and long-term benefits of good glycemic management.
At the same time, patients should be made aware that if insulin is injected into the tissue with subcutaneous fat hyperplasia, it will often lead to the use of larger doses of insulin to control blood sugar, and the result will affect the treatment effect and increase the cost of treatment, which is not worth the loss
.

At the same time, the psychological problems
caused by the pain caused by the injection should not be ignored.
Doing the following can help reduce the pain caused by injections:

• Opened insulin should be stored at room temperature;
• If alcohol is used for disinfection, wait for the alcohol to completely evaporate before injection;
• Avoid injections at the roots of the hair;
• Use shorter and thinner needles;
• A new needle is used for each injection
  .
  

For patients who will not rotate the injection position correctly, we can refer to the "Chinese Diabetes Drug Refraction Technical Guidelines (2016 Edition)" on the recommendation of injection site rotation:

1) A proven injection site rotation protocol: divide the injection site into four equal zones (thighs or buttocks can be divided into two equal zones), use one equal zone per week and always rotate clockwise
.

Figure 4 Correct rotation of injection sites

2) When injecting within any one subregion, two consecutive injections should be systematically rotated at least 1 cm apart (or about the width of an adult's finger) to avoid repeated tissue trauma
.

3) From the beginning of injection treatment, patients should be taught an easy-to-follow rotation protocol
.
Adjust as
treatment progresses as needed.
Healthcare providers should evaluate the patient's site rotation protocol
at least once a year.

4) Patients should be taught how to self-check the injection site, how to rotate the injection site, the correct injection technique, and how to check and prevent fat hyperplasia
.

Figure 5 Guidelines recommend injection sites

Problem 3: Injection needles are reused

As mentioned earlier, each insulin injection requires the use of a new needle, but in practice, there are still many patients who reuse needle injection
.
The main reasons are that patients think that carrying needles with them is a burden, using new needles for each injection is a waste of resources, and are unwilling to carry special sharps to store containers
.

But in fact, repeated use of needles often brings a lot of harm:

• Repeated needle use can affect the accuracy of the injection dose, because the used needle contains insulin crystals, which may block the needle and hinder the injection;

• The needle after injection is left on the insulin pen, and it will also cause errors
  in the dose of insulin due to thermal expansion and contraction.
  Studies have shown that repeated needle reuse will cause the needle to be rolled up and pricked, resulting in bleeding at the injection site and increasing injection pain;

• Pathogen contamination: the needle remains on the insulin pen and may cause air (or other contaminants) to enter the refill;

• Risk of subcutaneous fat hyperplasia: subcutaneous fat hyperplasia is more frequent in patients who reuse needles
  .