First ever guidelines for injecting insulin

Nov 07 2012, 10:47 IST
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SummaryThe guidelines are based on evidence-based recommendations by the Forum for Injection (FIT), India.

A specific set of guidelines on the correct injection technique in insulin therapy, a vital part of diabetes management, has been launched for the first time in the country. The guidelines are based on evidence-based recommendations by the Forum for Injection (FIT), India.

Dr Sanjay Kalra of the department of endocrinology at Bharti Hospital, Karnal, and chief author of the recommendations, told The Indian Express that a scientific advisory board of endocrinologists and diabetes experts laid down the FIT India guidelines based on a combination of clinical evidence, the implications for patient therapy and the judgment of the group of experts. Launched on Tuesday in association with Becton Dickinson and Company, the guidelines have been published in the Indian Journal of Endocrinology and Metabolism.

Insulin therapy is designed using high levels of technology to fine-tune and precisely time its peak of action and duration of action. However, if the technique used for injection is flawed, this then directly affects the way in which the insulin works and will affect the persons glycemic control, Kalra said.

So far, no recommendations or consensus statements have addressed such issues prevailing in developing countries such as India, said Dr H B Chandalia, former professor of medicine at Grant Medical College and currently endocrinologist at Jaslok Hospital in Mumbai. Although insulin therapy is accepted as one of the most effective and dependable treatment options in management of diabetes, there are several barriers to its usage among type 2 diabetic cases, particularly in acceptance of insulin, he said.

According to recent studies, 62.4 million Indians are affected with diabetes. By 2030, the prevalence of diabetes among Indians is projected to reach 87 million. About 1.2 million Indians depend on insulin injections.

Manoj Gopalakrishna, managing director of BD India, said, “Insulin treatment is the most important way for blood glucose control, but the inappropriate injection skill compromises its effectiveness. According to the guidelines the needle length for children and adolescents should be 4, 5 or 6 mm; adults including obese patients too can use 4,5 and 6 mm needle length. Ideally needles should not be reused and an easy to follow rotation scheme should be taught to patients from the onset of injection therapy. Pre-injection assessment and counselling has been advised apart from specific storage guidelines that have also been given.”


Check insulin vial for type and expiry date

Ensure that right insulin syringe is used with the right strength of insulin in use (eg 100U vial with 100U insulin syringe)

During initial step of drawing insulin, air equivalent to the dose should be drawn up first and injected into the vial

If air bubbles are seen in the syringe, tap the barrel to bring them to the top and then remove bubbles by slowly pushing up plunger

If it is cloudy insulin, mix it by rolling between the palms 20 times till the solution is clear or mix uniformly, but do not shake

Syringes should ideally be used only once and never be reused

Dispose of syringes safely after use

The injection site should not be massaged

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