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Injection guidelines for diabetes patients launched

Posted on Nov 16, 02:31PM | IBNS

The first Indian clinical recommendations for best practices in insulin injection techniques, Forum for Injection Techniques (FIT India) guidelines were launched on Friday in association with BD (Becton, Dickinson and Company), a leading global medical technology company.

So far, no recommendations or consensus statements have addressed such issues prevailing in developing countries such as India.

A scientific advisory board of well-known endocrinologists and diabetes experts led the FIT India guidelines based on a combination of clinical evidence, the implications for patient therapy and the judgment of the group of experts.

Although insulin therapy is accepted as one of the most effective and dependable treatment options in management of diabetes, there are several barriers to its usage among type 2 diabetes cases particularly acceptance of insulin therapy.

Dr. Sanjay Kalra, Department of Endocrinology, Bharti Hospital, Karnal and chief author of the recommendations (member, FIT India Advisory Board), said: "These guidelines emphasize the need for appropriate injection technique that is crucial for the success of insulin therapy. I am happy to be a part of the FIT India guidelines advisory board as my work will enhance both the duration and quality of life of people living with diabetes."

Traditionally, there has been a psychological resistance to initiation of insulin therapy in India. Insulin is the main injectable therapy used by people with diabetes and is designed using high levels of technology to finely tune its peak and duration of action which is precisely timed.

However, if the technique used for injection is flawed, the way in which the insulin works and will affect the patient's glycemic control is directly impacted.

Manoj Gopalakrishna, Managing Director, BD-India, said, "Insulin treatment is the most effective method for blood glucose control, but inappropriate injection techniques can compromise the effectiveness of insulin therapy.

"The FIT insulin injection guidelines are a timely initiative in India which will bring great benefit to patients and will help us to continue improving patients' experience with insulin injection."

An alarmingly rising prevalence of diabetes has been reported.

According to the recent studies, 62.4 million Indians are affected with diabetes.

By 2030, the prevalence of diabetes among Indians is projected to reach 87 million.

Insulin remains the mainstay of the treatment of diabetes and about 1.2 million Indians depend on insulin injections for the management of diabetes.

A specific set of guidelines to understand the best practices in insulin injection techniques are of utmost importance for patients as well as healthcare professionals.

Dr. Manash P. Baruah, Department of Endocrinology, Excel Center, Guwahati, said: "Correct insulin injection technique is critical for optimal control of diabetes. Improper use or reuse of injection devices, such as needles, may lead to undesirable consequences including pain with bleeding and bruising, breaking off and lodging under the skin, contamination, dosage inaccuracy and lipohypertrophy.

"Appropriate injection technique is thus an indispensable part of diabetes management. The FIT India guidelines have been developed based on these facts, and more so at a time when the government is taking every step to manage the disease in India."

Insulin injection recommendations:

Needle length

For children and adolescents, a 4, 5, or 6 mm needle should be used. A1

Adults, including obese patients, can use 4, 5, and 6 mm needle length. A1

Site rotation

An easy-to-follow rotation scheme should be taught to the patients from the onset of injection therapy. A2

Needle/syringe hygiene

Do not reuse needles. A2

Use a new needle for each injection. A2


Injection sites should be inspected at every visit. Patients should be taught to inspect their own sites and should also be given training on how to detect lipohypertrophy. A2

The best current strategies to prevent and treat lipohypertrophy are to rotate the injection sites with each injection, using larger injecting zones and non-reuse of needles. A2

Injection sites

Injection should be given at a clean site with clean hands. A2

Prior to the injection, the site has to be palpated for lipohypertrophy and inspected for wounds, bruises, or blisters. If the injection site shows any signs of these, then a different site should be selected until the problem has been resolved. A3

Safety issues

Safety needles should be recommended whenever there is a risk for a contaminated needle-stick injury. B1

Several factors, including the method of administration, dosing, compliance, selection of injection site, depth of the injection, time lapse before withdrawing the needle and misconceptions about insulin therapy, influence the success of insulin injection therapy