Today, for quite a few diabetics, insulin is the main, unique, and sometimes the only method of treating the most complicated ailment, or, more precisely, the introduction of its subcutaneous injections. To do this, the patient should learn to adhere to certain rules on which the outcome of his upcoming struggle depends. The effect of this drug is influenced by the following factors:
- physical exercise;
- place of administration;
- dose of the drug;
- skin and insulin temperature;
- massage of the injection site;
- injection depth.
If the injections are performed correctly and regularly, then diabetes mellitus simply cannot adversely affect the person’s well-being, but some people still have some difficulties with this treatment process.
Scars after injections in diabetics
Sometimes patients, from continuous and long-term insulin treatment, complain to their doctors that it is no longer possible to make an injection to most places on the body. This fact is reflected in the well-being and mood of the patient, because it is necessary to continue to perform daily administration of the drug, and the injured areas of the body do not provide such an opportunity. This problem is really common among patients with type 1 diabetes, they often turn to it to doctors, and therefore we can not give specific recommendations in this situation.
Injection of a specific drug causes some tissue damage and triggers an appropriate immune response at the injection site. This situation, as a rule, should not be a serious cause for unrest and anxiety, because any injury (including this injury) heals without any particular consequences. However, it is necessary to take into account that when injections of the drug are regularly and permanently administered in one place, permanent inflammation develops in it. This phenomenon leads to an unpleasant consequence – the formation of specific scars that interfere with the normal circulation and, accordingly, prevent the penetration of the required amount of insulin into the cells. That is, if a person injects medication into the place of the scar, it simply will not be able to fully enter the bloodstream, and this is fraught with a deterioration in glucose control .
What will help get rid of the problem
Tissue massage will not be able to alleviate the condition, but there are several recommendations that, after listening to which a person will be able to improve the situation. Of course, you can restore the injured areas on your body simply by completely eliminating the introduction of the drug into them for several months. A diabetic should know that he has more than two hundred available places that are allowed to be given injections, and it is foolish to believe that the inflamed areas are the most optimal. It is impossible to continue to inject insulin directly into already injured places, because this not only worsens their condition, but also reduces the effectiveness of treatment.
Diabetics should try to avoid the formation of scars, besides it is always within their power. It is necessary to change the places of injections regularly and correctly, not to give an injection to the same place for a short time period, the doctors advise to retreat from the last injection site by at least a couple of centimeters. We note that modern insulin in diabetes mellitus leads to scarring less often than its early versions, and you can always discuss this issue with your endocrinologist.
To make insulin injections safe, painless, and effective.
The ability to properly inject insulin is an integral part of diabetes treatment for those patients who use them. This article focuses on news related to the correct technique for administering insulin and choosing needles of the correct length for insulin injectors (hereinafter: – insulin pens). In September 2016, the recommendations of the Mayo Clinic (USA) on the administration of insulin were published. 183 diabetes specialists from 54 countries of the world participated in the development of recommendations. Compliance with the recommendations will allow you to avoid such complications as, for example, lipohypertrophy or local increase in adipose tissue in places of constant insulin administration, bruises (hematomas) and insulin penetration into muscle tissue, which can cause the development of severe hypoglycemia.
New items on choosing needles of suitable length for insulin pens
In order for insulin to be properly absorbed, it must be injected subcutaneously, and choosing a needle of the correct length for an insulin pen is important. Currently in Latvia, needles of 4, 5, 6, 8, 10 and 12 mm are available. In order to choose a needle of the correct length, for many years it was recommended to take into account the age and weight of a person: the greater the weight, the longer the needle. However, studies have shown that the subcutaneous layer can be of different thickness in different places, despite the weight and body mass index. That is, in a person with an increased weight, the thickness of the subcutaneous layer can be normal, reduced or increased.
In the newest research it was proved that insulin injections should be made to any patient with diabetes mellitus with the shortest insulin needle. – 4–5 mm
Short needles are just as effective as long ones, and at the same time safer, reduce the risk of bruising, and at the same time the risk of hypoglycemia, which increases the likelihood of a longer needle entering the muscle tissue.
There is no evidence that insulin does not enter the subcutaneous layer if shorter needles are used for insulin pens, so there is no risk that insulin will not work. At the moment, it is believed that needles for insulin pens with a length of 4–5 mm are the first choice. The rationale is given above.
For needles of different lengths there are different injection techniques.
With the correct injection technique, using a needle for an insulin pen 4–5 mm long, the injection should be made at an angle of 90 degrees without catching the skin.
Therefore, insulin can be injected into the front wall of the abdomen and the outer side of the thigh, as well as alternatively into the shoulder and upper outer part of the thigh. In the field of alternative insulin injections can be done, but not grabbing the skin. The ability to use as many places as possible to administer insulin (on the rotation principle) avoids the risk of lipohypertrophy . It is necessary to take into account that lipohypertrophy is a problem not only cosmetic! If you continue to inject insulin in places with lipohypertrophy , insulin absorption significantly changes, which can provoke both hyperglycemia (elevated blood sugar levels) and hypoglycemia (low blood sugar levels).
When using needles with a length of 6–8 mm and more, the angle of the injection should be 45 degrees, and, regardless of the age and thickness of the subcutaneous layer, the skin should be gathered in a fold. This means that it is impossible to make an injection into the shoulder and the upper outer thigh without assistance, since it is impossible to capture the skin, so the injection is made into the front wall of the abdomen or the outer part of the thigh.
In different parts of the body, insulin is absorbed at different rates.
It must be remembered that insulin is absorbed from the front wall of the abdomen faster, and from the outside of the thigh – slower. Therefore, it is usually recommended to introduce fast-acting insulin (before meals) in the front wall of the abdomen, and long-acting drugs – in the thigh. If you use the combined insulin preparations, put them in the morning in the stomach, and in the evening – in the thigh.
It is important to regularly change the place of introduction of insulin.
Change the place of injection of insulin so that they are at a distance of at least 2 cm from each other, on the principle of rotation! Figure 2 shows how to change insulin injection sites by injecting insulin in one place for one week; at the same time, fast-acting insulin is inserted into the front wall of the abdomen, and long-acting drugs – into the outer part of the thigh.
Injection of insulin should not be done in scars, next to postoperative scars, with pronounced superficial veins, near infected wounds, in places of lipohypertrophy , closer than 2 cm from the previous injection site.
Often arising the difficulties
- Before injection, release the air from the needle!Turning the introduction button, select two units. Hold the insulin pen with the needle up. Hit the cartridge lightly so that air collects in its upper part. Holding the insulin pen with the needle up, press the dose button all the way down (to the number 0 in the dose window). Charging is done when a trickle or insulin drop is poured from the needle. If there is no insulin stream, repeat the charging process no more than 4 times. If insulin is not shown from the needle when repeating the action, change the needle.
- Correctly grab the fold of skin!The fold is formed with a slight seizure of the skin and subcutaneous layer with the thumb and index finger and / or middle finger, lifting it up. Muscle must be in a horizontal position
- The fold should be held until insulin is injected.Inject insulin, slowly counting to 10. Then release the crease, wait 10 seconds and charge the needle. Do not massage the injection site, but clamp it with a cotton swab or napkin.
- Do not store an insulin pen with a loaded needle.To prevent air from entering the cartridge, remove the needle after each injection.
Complications after insulin injections
The subcutaneous layer has a rich blood supply, therefore, with the introduction of insulin every day at the injection site may form a bruise, or hematoma . The reason may be the use of too long a needle, and reuse of the same needle. Change the needles in the insulin pen often enough – this will reduce discomfort if insulin is injected every day!
If insulin flows out of the cartridge before the injection , it may be due to the storage of the insulin pen along with the needle (if the needle is not removed after the injection) or with a wrongly inserted needle.
If insulin is released from the injection site after an injection, this may be due to the introduction of too much insulin. Dose greater than 40-50 units , it is recommended to divide into two parts. A second reason for insulin leakage from the injection site may be too quick to remove the needle after the injection. As mentioned above, after the introduction of insulin, the skin fold needs to be released, wait 10 seconds and only then remove the needle, pressing the injection site with a cotton swab or a napkin.
One of the most unpleasant complications after insulin injections is lipohypertrophy — a local increase. whether adipose tissue in places sec insulin administration. In order to avoid the development of a lipohyper trophic , it is necessary to change the place of insulin. whether the risk by hypertrophy also increases repeat Needle use as this injures the tissue.
- Needles with a length of 4–5 mm are safer and more effective, injections with such needles are less painful, there is no need to grab a fold of skin, and injection into the muscle can be avoided, which can cause hypoglycemia.
- It is strictly forbidden to inject insulin into the place withlipohypertrophy – tissue deterioration . In order to avoid the development of lipohypertrophy , it is necessary to change the place of administration of insulin.
- Each injection of insulin is recommended to make a new needle, as the reuse of the needle increases the risk of infection andlipohypertrophy .
- Proper selection and use of needles for an insulin pen contributes to the effectiveness of your treatment.