FIT India and BD India launch insulin injection guidelines

Raelene Kambli – EH News Bureau

Forum for Injection Techniques (FIT India) and BD India have come together to launch the first Indian clinical recommendations for best practices in insulin injection techniques. This was done in order to promote best practices in injection technique for diabetes patients and healthcare professionals. The recommendations include several factors, such as: 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 etc.

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 compiled the FIT India guidelines based on clinical evidence, implications for patient therapy and the judgement of a group of experts.

Speaking to Express Healthcare, Dr A Sundaram, Retd HOD, Department of Endocrinology, Ambedkar Institute of Diabetes, Govt Kilpauk Medical College, Kilpauk, Chennai and one of the members of FIT advisory board said, “It is important to inspect and palpate the sites of injection. As a teacher I feel there is a need for insulin injection guidelines for doctors during/after graduation as it is not a part of their curriculum. It was my dream to set such guidelines to be followed by doctors, practitioners, diabetes educators and nurses. These recommendations will bring uniformity in insulin injection technique throughout the country and help discipline healthcare providers to follow a set of rules thereby help people living with diabetes. Moreover, it will help the doctors and HCPs to impart right knowledge about insulin injection techniques which in turn will help the patients to lead good quality of life by achieving normoglycemia”.

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
Lipohypertrophy	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

Adding to this, Dr Manash P Baruah, Department of Endocrinology, Excel Center, Guwahati stated, “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.”

Additionally, Dr Laurence Hirsch, VP Global Medical Affairs -Diabetes Care, BD Medical , said, “The India recommendations for doing the insulin injections are simple. These should help diabetes educators, nurses, or practitioners who teach people how to give injections.”

Speaking about BD’s association with FIT guidelines, Dr Hirsch added, “Living with diabetes is a challenge. Until a cure is found, BD’s goal is to make disease management as comfortable as possible for people with diabetes, which increases the likelihood that they will adhere to their treatment. Injecting insulin every day can cause discomfort for patients and is particularly challenging for parents of children with diabetes. BD is committed to improving the injection experience, as demonstrated by our long history of innovative firsts, including the first insulin syringe in 1924 and the first 5mm pen needle in 1999”.