April 23, 2025
3 min learn
Key takeaways:
- A gaggle of specialists up to date the FITTER insulin injection suggestions for the primary time since 2016.
- The report consists of new steering on needle dimension and the angle at which injections must be carried out.
Up to date suggestions from a global group of diabetes specialists purpose to tell diabetes educators about finest practices for insulin injections.
The Discussion board for Injection Method and Remedy Knowledgeable Suggestions (FITTER) revealed up to date steering in Mayo Clinic Proceedings on how sufferers with diabetes must be administering insulin injections. The paper, referred to as “FITTER Ahead,” was the primary replace to the group’s steering since 2016.
The “FITTER Ahead” steering revealed in Mayo Clinic Proceedings supplies suggestions for a way individuals with diabetes ought to inject insulin. Picture: Adobe Inventory
David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, medical director of the Diabetes Analysis Institute at Mills-Peninsula Medical Middle and lead creator of the paper, mentioned why it’s essential for well being care professionals to teach and practice individuals with diabetes on methods to carry out injections, particularly if they’re first beginning to use insulin.
“We can’t take it without any consideration that an individual who shouldn’t be a well being care skilled is injecting themself correctly,” Klonoff informed Healio. “We assume they’re doing it proper, however as soon as it some time, they aren’t. It’s about ranging from the fundamentals.”
Injection suggestions
David C. Klonoff
The FITTER Ahead suggestions are divided into 4 sections. After a piece on how the physiology of insulin, gadgets and injection approach impacts the injection expertise, researchers mentioned how correct injection strategies can have an effect on the efficacy of insulin remedy. For insulin injections, researchers advocate utilizing a needle that’s 4 mm in size with a 32 gauge width, a sharpness of 5 bevels and a contoured base.
“We got here up with a suggestion that the optimum size of a needle is 4 mm,” Klonoff mentioned. “Some individuals have used longer needles prior to now, pondering the deeper it’s, the higher it’s. However once you use an extended needle, there’s the chance it is going to attain the muscle.”
Insulin must also be injected at a 90° angle reasonably than a forty five° angle, in line with the report.
After an injection, the paper discusses the significance of correct needle disposal and why individuals with diabetes shouldn’t reuse needles.
The injection approach part additionally discusses insulin storage. The paper recommends storing unopened insulin in a fridge with a temperature of 36°F to 46°F.
One part of the suggestions discusses lipodystrophy issues that may happen with improper insulin injections. A big focus was positioned on lipohypertrophy, which is a swelling or enlargement of adipocytes. Klonoff mentioned the situation, which will be recognized by means of ultrasound or by feeling bumps or abnormalities on the pores and skin, can happen with poor injection approach or by injecting insulin in the identical spot incessantly as a substitute of rotating to completely different websites on the physique.
“[Lipohypertrophy] is available in completely different shapes, however in case you can really feel it, you have already got a major problem,” Klonoff mentioned.
Affected person schooling
The ultimate part of the article examines how well being care professionals play a significant function in educating individuals with diabetes about insulin injections. The part focuses on discussing the scientific, emotional and social wants of individuals with diabetes concerning their insulin routine. The paper additionally emphasizes early schooling for individuals not too long ago recognized with diabetes, giving individuals with diabetes their alternative of insulin supply gadgets and utilizing visible instruments throughout injection schooling.
Klonoff mentioned it’s also vital for well being care professionals to establish when an individual with diabetes could also be battling injections.
“In case you see that an individual’s glucose ranges are unpredictable and they’re having hypoglycemia, each of these are warning indicators that they aren’t injecting correctly,” Klonoff mentioned.
Klonoff added that injection suggestions aren’t solely relevant to individuals who use insulin.
“Insulin shouldn’t be the one peptide drug that’s utilized by individuals with diabetes, now that GLP-1 medication and associated incretin medication are used,” Klonoff mentioned. “There hasn’t been a FITTER-type article for [GLP-1s], however the ideas we talked about would pertain to these medication.”
One space the FITTER Ahead suggestions don’t contact on is alternate insulin supply strategies similar to patch pumps, inhaled insulin or needle-free injectors. The authors wrote {that a} separate set of suggestions could also be wanted to cowl alternate insulin supply strategies.
For extra data:
David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, will be reached at dklonoff@diabetestechnology.org.
Sources/Disclosures
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Disclosures:
Klonoff reviews consulting for Afon, Atropos Well being, Embecta, Glucotrack, Lifecare, Novo Nordisk, SynchNeuro and Thirdwayv. Please see the examine for all different authors’ related monetary disclosures.
