VOLUME 11 NUMBER 2 • JUNE 2014
95
SA JOURNAL OF DIABETES & VASCULAR DISEASE
BEST PRACTICE
T
he incorrect administration of insulin
injections contributes to complications
associated with South Africa’s growing
diabetes burden and makes problems
worse.
1
But this is about to change. Earlier
this year, South Africa became the sixth
country worldwide and the first in Africa to
benefit from the introduction of guidelines
for optimal injection technique for diabetes
control. ‘Needles have come a long way and
are shorter and thinner than in the past,
which has helped us to work around doctor
and patient reluctance to initiate insulin’,
says paediatric endocrinologist, Dr David
Segal. ‘These guidelines are important to
ensure uniformity in respect of how patients
administer insulin and how healthcare
professionals advise them with regard to
correct techniques.’
The guidelines were made public at an
official launch on 10 April 2014 prior to
the annual SEMDSA conference and are
specifically tailored to South Africa and
its needs. They were created by the South
African Forum for Injection Technique (FIT),
made up of experienced specialist diabetes
nurses, whose chairperson, Hester Davel,
underlines the need for action. ‘Reliable
statistics are not readily available but data
held by companies that supply insulin and
other injectable therapies suggest that some
200 000 people in South Africa currently use
injectable therapies to treat their diabetes.
We intend making life easier by guiding
those who are injecting on the best injection
techniques available.’
Razana Allie, a diabetes nurse educator
and member of the FIT steering committee,
adds: ‘Education is key to the effective
management of diabetes and this includes
education on how to use medication.
Simplifying and improving diabetes control
for patients and caregivers will have huge
benefits in the longer term. It will improve
overall quality of care, minimise individual
complications and increase the cost-
effectiveness of diabetes control resources.’
Incorrect injection technique on its own
complicates the management of diabetes.
1,2
New guidelines address problems associated with suboptimal injection
technique
When insulin is prescribed, the appropriate
administrationdevicesandneedlesfrequently
aren’t given. Inaddition, consistent education
on correct technique is lacking. Allie explains
that incorrect technique, including use of
Best Practice
inappropriate needle lengths, failure to
rotate injection sites and reuse of needles
can lead to unpredictable absorption of
insulin.
3
Injecting insulin into muscle where
it is absorbed at a faster rate may cause
hypoglycaemia. If the insulin is injected into
an area where it is poorly absorbed, it may
lead to hyperglycaemia.
3-5
‘Thehealth scene in the countryhas shifted.
The StatsSA report on the causes of mortality
in the country released in March confirms
the trend showing that the incidence of non-
communicable diseases is strongly upward –
the four main types are cardiovascular disease,
cancer, chronic respiratory diseases and
most definitely diabetes. We intend helping
people with diabetes help themselves’, says
Peter Mehlape, general manager of Becton,
Dickinson and Company (BD), a global
medical devices manufacturer and supporter
of the initiative. ‘As a technology partner we
support the continuing education of both
healthcare workers and patients to ensure
successful disease management and make
life easier for those with diabetes.’
Davel concludes: ‘Knowing what to do
and how to do it will now make a powerful
combination in the efforts to improve
diabetes control.’
For more information, visit
south-africa/
P Wagenaar
1.
Strauss K, De Gols H, Hannet I,
et al
. A pan-
European epidemiologic study of injectable therapy
injection technique in patients with diabetes.
Pract
Diabetes Int
2002;
19
: 71–76.
2.
Blanco M, Hernandez MT, Strauss KW, Amaya M.
Prevalence and risk factors of lipohypertrophy in
insulin-injecting patients with diabetes.
Diabetes
Metab
2013;
39
(5): 445–453.
3.
Frid A, Hirsch L, Gaspar R,
et al.
New injection
recommendations for patients with diabetes.
Diabetes Metab
2010;
36
(Suppl 2): S3–S18.
4.
Gibney MA, Arce C, Byron K, Hirsch L. Skin and
subcutaneous adipose layer thickness in adults
with diabetes at sites used for insulin injections:
implications for needle length recommendations.
Curr Med Res Opin
2010;
26
(6): 1519–1530.
5.
Vardar B, Kizilci S. Incidence of lipohypertrophy in
diabetic patients and a study of influencing factors.
Diabetes Res Clin Pract
2007;
77
(2): 231–236.
TEN BEST-PRACTICE RECOMMENDATIONS
Needle length
1. For all children and adolescents a 4-, 5- or
6-mm needle should be used.
2. Adults, including obese patients, can use 4-,
5- and 6-mm needles.
Site rotation
3. An easy-to-follow injection site rotation
scheme should be taught to patients from
the initiation of injection therapy.
Needle/syringe hygiene
4. Ideally do not reuse needles.
Lipohypertrophy
5. The injection site 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.
6. The best current strategies to prevent and
treat lipohypertrophy are to rotate the
injection site with each injection, using
larger injection areas and with non-reuse of
needles.
Injection sites
7. Injection should be given at a clean site with
clean hands.
8. Prior to the injection, the site has to be pal-
pated for lipohypertrophy and inspected for
wounds, bruises or blisters. If the injection
site shows any signs of these, then a differ-
ent site should be selected until the problem
has been resolved.
Safety issues
9. Safety needles should be recommended
whenever there is risk of a contaminated
needle-stick injury.
10. Correct safe disposal of needles/syringes is
essential.
