Tips for injecting insulin

Jessica Oosthuizen shares some useful pointers when injecting insulin.


Insulin therapy remains a fundamental and essential part of diabetes management. Many patients with Type 2 diabetes and all patients with Type 1 diabetes require insulin to keep blood glucose within target ranges.

However, this practice is still not performed optimally in many healthcare facilities, and insulin therapy is only effective if delivered into the correct tissue in the correct way.

The goal of exogenous insulin (insulin that is not made by the body but injected) is to reliably deliver the medication into the subcutaneous tissue, without causing any pain or discomfort and without any leakage of insulin.

The aim is to prevent injecting into the muscle. Injecting into the wrong space can affect the absorption and action of insulin. This can lead to unpredictable blood glucose control. To achieve this objective, it is important to select a needle that is the correct length.

What needles should be used for injecting insulin?

Studies have shown that shorter needles of 4mm are as safe and well-tolerated in comparison to longer ones.

Needles come with a different diameter and length. Those with a higher gauge number have a smaller needle diameter. Needles are available in 4-, 5-, 6- or 8-mm. Needles with a length of 12,7mm have an increased risk of intramuscular injection (which you want to avoid).

It is often assumed that a heavier person, with a higher BMI, may require a longer needle. However, we now know that 4-, 5- or 6-mm needles are suitable for all people with diabetes. Regardless of their BMI.

Insulin therapy should ideally be started using shorter length needles and these injections should be given at 90 degrees to the surface of the skin.

Children and teenagers

Children and adolescents should only be using needles with a length of 4-, 5- or 6mm. There is no clinical reason for using needles longer than 6mm. When injecting insulin into limbs, a skin-fold may be necessary, especially when using a 5- or 6mm needle.

Adults

In adults, including those with a high BMI in the overweight or obese category,  a needle that is 4mm, 5mm or 6mm in length should be used. There is no clinical reason to be using a needle >8mm. Patients who are using these needles should ideally change to a shorter needle. If this is not possible then lifting a skin-fold and/or injecting at a 45 degree angle should be adopted to avoid an intramuscular injection.

Injecting insulin into the muscle will cause: your body to absorb it too quickly; a more painful injection; and a shorter duration of insulin action time.

How many times can you use the same needle?

In a perfect world insulin needles would be used once and then safely discarded. Yet, realistically it’s common practice for needles to be reused. Especially, in a country, like South Africa, where resources are limited in both state and private sectors.

Although the risk of complications is relatively low in relation to the reuse of needles, some evidence does show that the reuse of needles can cause an increased risk of lipohypertrophy. This refers to swelling of the fatty tissue under the skin which causes fat lumps. It’s a relatively common side effect of insulin injections and can occur if multiple injections are given around the same area repeatedly.

Lipohypertrophy causes inconsistent and unpredictable insulin absorption, which can result in unexplained hypoglycaemia and glucose variability. It is for this reason that proper rotation of injection sites and regular changing of needles is essential.

Priming your pen

It’s important to remember that your insulin pen device should always be primed before the first dose and after every needle change.

Priming helps to remove any air bubbles that can collect during everyday use of your pen and ensures that you receive the full dose when administering insulin.

To prime your pen, dial up 2 units, hold your pen with the needle facing upwards and press down on the plunger. If you see drops of insulin come out at the top of the needle, then you know that your pen has been primed.

However, if you don’t see a flow of insulin then you must repeat the steps and continue until drops of insulin are visible at the top of the pen.

These same steps can be followed if you notice an air bubble in your pen. If an air bubble is present and you don’t remove it then you will not receive the correct dose of insulin.

You will notice this when you inject yourself. The air bubble causes a negative pressure when pointing the needle downwards into your skin and you will see a flow of insulin that is not injected and rather ‘spills’ out when removing the needle.

Final comment

Choosing the correct needles and ensuring removal of air when priming your insulin pen are two things that are easy enough to do. They can have positive effects on blood glucose control for people living with diabetes requiring multiple daily injections.


References

  1. FIT forum for injection technique in South Africa. Recommendations for best practice in injection technique. 1st 2014.
  2. Kreugel, G., Keers, J., Kerstens, M. and Wolffenbuttel, B. (2011). Randomized Trial on the Influence of the Length of Two Insulin Pen Needles on Glycaemic Control and Patient Preference in Obese Patients with Diabetes. Diabetes Technology & Therapeutics, 13(7), pp.737-741.
  3. Shah, R., Shah, V., Patel, M. and Maahs, D. (2016). Insulin delivery methods: Past, present and future. International Journal of Pharmaceutical Investigation, 6(1), p.1.
  4. Frid, A., Kreugel, G., Grassi, G., Halimi, S., Hicks, D., Hirsch, L., Smith, M., Wellhoener, R., Bode, B., Hirsch, I., Kalra, S., Ji, L. and Strauss, K. (2016). New Insulin Delivery Recommendations. Mayo Clinic Proceedings, 91(9), pp.1231-1255.
  5. Bahendeka, S., Kaushik, R., Swai, A., Otieno, F., Bajaj, S., Kalra, S., Bavuma, C. and Karigire, C. (2019). EADSG Guidelines: Insulin Storage and Optimisation of Injection Technique in Diabetes Management. Diabetes Therapy, 10(2), pp.341-366.

MEET OUR EXPERT


Jessica Oosthuizen is a registered dietitian and works in private practice at the Wits Donald Gordan Medical Centre. Being a Type 1 diabetic herself, since the age of 13, Jessica has a special interest in the nutritional management of children and adults with diabetes. She also has a key interest in weight management and eating disorders.


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Winter tips for diabetics

Novo Nordisk South Africa shares five winter tips for diabetics.


Beanies, gloves, boots and jackets. These are the clothing items that help us keep warm during the cold winter months we find ourselves in currently. Coupled with heaters and hot beverages, many of us feel ready to brave the cold and chilly days ahead.

For people living with diabetes, winter is a time of adjustments. This is because during colder months diabetes patients have higher HbA1c levels than over the warmer months.[1]This increase can be attributed to changes in their diet and exercise, and the prevalence of colds and flu[2]. Therefore, people living with diabetes need to be extra vigilant and adjust their management plans during the colder months. Here are some tips and tricks to help you get through winter:

  1. Keep testing your blood sugar levels

Did you know that cold hands can make testing your blood glucose levels difficult? The trick is to try and warm your hands before you do the blood glucose test. Testing regularly will assist with catching any highs, or lows, and keep your sugar levels under control[3].

  1. Keep active even in the cold

Keeping active is important. Even though all you may want to do is stay indoors, under warm blankets and heaps of clothing. Even if the amount of physical exercise decreases, that is okay. As long as you do some form of exercise. It will help keep your blood glucose levels under control and keeps you warm in the process.

You can even start an indoor workout routine if bracing the cold doesn’t sound very appealing. A little activity each day will help with insulin sensitivity (in all types of diabetes) which can help the body to better regulate sugar levels[4].

  1. Watch what you eat

Winter food can be thought of as ‘comfort food’ because our bodies may require extra intakes to defend itself against the cold. So, where possible, stick to your meal plans.

You can also take advantage of diabetes-friendly seasonal fruits and vegetables in moderation, such as citrus fruits, nuts, root vegetables, and varieties of squash. Be careful of the easy and quick meals which only raise blood glucose[5].

  1. Boost your immunity

We know winter is when colds and flu take over and living with a chronic disease means taking even more precautions. Speak to your doctor about whether you should be taking medication in the event that you do get a cold or even about getting the flu vaccination. Bear in mind that when you do catch a cold or the flu, your energy levels decrease and your blood glucose levels could rise in response to the illness[6].

  1. Avoid the winter blues

Cold, unpleasant weather, lack of sunlight and stress in itself can cause blood sugar to rise. This is due to the body tapping into its stored glucose supplies and releasing sugar into the bloodstream – ‘preparing for battle’, i.e. making more sugar available to have the energy to fight whatever is causing you to feel stressed.  This is an example of how emotional and physical health are finely balanced in diabetes. So, it’s crucial to take care of both during winter[7]. It is therefore important to speak to friends and family if you are feeling overwhelmed, anxious or if you think you may be suffering from depression.

All it takes is a bit of extra effort to get through the shorter days and lack of sunlight. Making the necessary adjustments will ensure you are well equipped to make it through this winter.

Article supplied by Novo Nordisk South Africa.


References:

  1. 7 Tips to Keep Blood Sugar Under Control in Winter: https://diabeteshealthpage.com/tips-blood-sugar-control-winter/ Last accessed 08 June 2018
  2. 7 Tips to Keep Blood Sugar Under Control in Winter: https://diabeteshealthpage.com/tips-blood-sugar-control-winter/ Last accessed 08 June 2018
  3. Diabetes and Cold Weather: https://www.diabetes.co.uk/diabetes-and-cold-weather.html Last accessed 11 June 2018
  4. Diabetes and Cold Weather:https://www.diabetes.co.uk/diabetes-and-cold-weather.html Last accessed 11 June 2018
  5. 7 Tips to Keep Blood Sugar Under Control in Winter: https://diabeteshealthpage.com/tips-blood-sugar-control-winter/ Last accessed 11 June 2018
  6. [1]Diabetes and Cold Weather: https://www.diabetes.co.uk/diabetes-and-cold-weather.html Last accessed 11 June 2018
  7. Taking care of your emotional health: https://www.novonordisk.com/patients/diabetes-care/type-2/Living-type-2-diabetes/Emotional-health.html Last accessed 12 June 2018

Improve your health at work

It’s Employee Wellness Week in South Africa from 1 to 5 July. South Africans are encouraged to participate in wellness within their workplace.


How important is wellness at work?

Extremely! A physically, mentally, and emotionally well employee is a productive employee. A healthy work atmosphere also enables positive morale and job satisfaction. 

With an estimated 56% of women and 29% of men being overweight and obese in South Africa, corporate wellness should be a top priority at all organisations. Further alarming facts show that 1 in 3 men and 1 in 4 women in South Africa will develop a heart condition before the age of 60. Heart disease and strokes are the biggest non-infectious killers in our country while heart attacks and strokes are two of the major health complications which cause premature deaths in people with diabetes.

Did you know that up to 80% of these are due to our lifestyles and behaviour? Which means that 80% of premature deaths can be prevented through lifestyle changes.

Employee Wellness Week

The focus of this week is on wellness in the workplace and encouraging all personnel to follow a healthy lifestyle, even at work. Investing in employees’ health through Employee Wellness Programmes (EWP) is increasingly being recognised as a value-add for both the company and its people.

Companies are benefiting through reduced absenteeism, improved productivity and lower medical costs. Individual benefits are risk reduction in heart disease and strokes, and other occupational conditions, such as stress related illnesses, knowing your numbers and what puts you at risk.

Employees are the backbone of any organisation and if they are in top shape mentally, emotionally as well as physically, it benefits both the organisation and the employees to reach goal of productivity.

Improve your health at work

  1. Step up! Opt for the stairs instead of the elevator – it’s a great way to get in shape.
  2. Experience yoga, it helps with focus, flexibility, and posture.
  3. Stay hydrated! Drink at least eight glasses of water a day.
  4. Snack well! Choose to snack on fruit or yoghurt during your work day instead of sweets and chocolates.
  5. Laugh! Don’t allow work to become mundane. Take time to share a joke with a colleague or laugh at an email. Laughter is a great stress reliever.

For more information go to www.heartfoundation.co.za or find us on Facebook @HeartStrokeSA or on Twitter @SAHeartStroke

Jogging safety tips

Jogging provides the perfect opportunity to keep fit and enjoy the outdoors, however, it is important for runners to keep road safety top of mind while heading out on foot. Imperial Road Safety share five jogging safety tips.


Road safety should not only be a priority for motorists; it is of even more importance for runners, who are exposed to all kind of risks – one of which are unaware and/or reckless drivers. So, before you head out for your next jog, here are jogging safety tips to keep top of mind.

Leave a message

Before you head out for your jog, make sure that there is always someone who knows where you are going. We live in a digitally connected world that has made it easy to inform someone of your whereabouts. Let your family, friends or even your next-door neighbour know you have stepped out for a jog, and give them details on your planned route.

Run on the same side as oncoming traffic

While out on the road, run facing the oncoming traffic; this assists motorists, approaching your direction, in being able to see you better. Also, if anything happens in front of you, you can react quicker and possibly avoid accidents as opposed to having your back against traffic.

Wear visible clothes

The importance of being highly visible while running cannot be stressed enough. Always ensure that you wear high-visibility, brightly coloured clothing, irrespective of what time of day you are taking a jog.

For those who prefer jogging in the evenings, invest in a headlamp or handheld jogging torch so you can see where you’re going. The other road users will see you, and more importantly, avoid knocking you over.

Obey the rules of the road

While jogging, it’s often easy to forget the normal rules of the road. Therefore, it is important to be more alert while on the road. Obey the rules of the road. Remember motorists have the right of way in South Africa, unless you are running in an estate or complex that has a specific running track. More importantly, don’t forget to look right, look left, and right again before running across a road.   

Avoid wearing earphones

Most joggers prefer to play their favourite tunes to keep them motivated. However, this can have dangerous consequences. How are you able to hear anything around you, including approaching vehicles and hooters, if you have music playing full blast in your ears?

If you can’t do without your headphones, lower the volume instead. Keep it at a level that still allows you to hear what is going on around you. Another consideration is to only wear your earphones in one ear, leaving the other ear free of sound and able to identify any alerts.

jogging safety tips

The IMPERIAL Road Safety programme aims to create a sustainable and viable way of changing the perceptions and behaviours of road users, to encourage responsible road usage in South Africa from grass root level upwards.