Right injection use key to diabetic health

Diabetes is a lifestyle disorder characterised by high blood glucose levels. It is commonly associated with high blood pressure and blood cholesterol levels, too. Over time, it can lead to serious complications like kidney failure, blindness, heart disease, stroke, amputation of limbs and premature death. Currently, India is second only to China, which has the maximum number of diabetics.

Even though a myriad oral agents are available to control blood glucose levels, insulin still remains a popular choice for treatment. Discovered by Sir Frederick G Banting, Charles H Best and JJR Macleod and purified by James B Collip in 1921, insulin was first used in the treatment of diabetes in January 1922. Before its discovery, it was exceptional for people with Type 1 diabetes to live more than a year or two.

Approximately, 1.4 million Indians take insulin injections annually. It is estimated that one out of every four diabetics world over, who are prescribed insulin injections are reluctant to take them and continue oral medications which may not control blood glucose effectively.

Resistance to start insulin therapy, called Psychological Insulin Resistance (PIR), affects millions of people worldwide. Insulin phobia makes it difficult to manage the disease for the patient and doctor alike.

In the study, “Measuring Psychological Insulin Resistance: Barriers to Insulin Use” by American Association of Diabetes Educators, fear of injections was found to be the reason for refusal to take insulin injections in 67 per cent of patients.

The phobia could partly be due to lack of awareness not only about correct injection techniques; but also about the availability of new range of shorter and narrower gauge needles (as narrow as 4mm – less than the size of an eyelash!).

The consensus is that healthcare professionals need to work closely with patients to address these personal and social issues to allay fears in connection with insulin therapy. Diabetes educators are working in this area, hand-holding with patients to make the switch easy and thereby improve the patient’s quality of life.

A good injection technique is vital in achieving good glycaemic control and thereby, preventing chronic complications. Needle length is important to dispel the fear of injections. The shorter the needle, the lesser the psychological barrier. Shorter and thinner needles, which are now widely available, are safe and avoid injecting into muscle. Insulin injected inadvertently into the muscle may lead to hypoglycemia.

It is also difficult for physicians to convince patients against repeated use of the same needle. A needle should be ideally used only once. If used multiple times, the blunt tip may lead to pain which might lead to discontinuation of the insulin therapy. Equally important is the awareness about appropriate injection technique, including sites of insulin injection and site rotation.

Promoting better practices

A scientific advisory board of endocrinologists and diabetes experts compiled the FIT India recommendations based on clinical evidence, implications for patient therapy to promote best practices and uniformity in insulin injection technique amongst diabetes patients and healthcare professionals.

In the past one year, FIT has launched the first ever India-specific clinical recommendations for appropriate insulin injection techniques and reached out to 15,000 healthcare providers and patients in more than 180 hospitals.

The FIT recommendations state that correct injection technique can help protect against lipohypertrophy (swelling or lump), unexplained hypoglycemia (low blood glucose) and blood glucose variability (wide swings of high and low blood glucose).

The success of insulin injection therapy and the adherence to it depends on several factors, such as a smooth insulin initiation process with counselling that alleviates the fear of needles, the insulin regime, length of needle and the method of administration.

For example, it is always pre-ferable to keep injectable therapy at room temperature, use a new needle for each injection, choose shorter needles with a smaller diameter, and inspect and palpitate the skin prior to each injection to ensure a comfortable injection experience.

If injection devices like needles are used improperly or re-used, it can result in pain with bleeding and bruising and needles breaking off, among other complications.

On the other hand, if the right needle size is selected and administered properly, patient can adopt the therapy with no discomfort at all. Only with a little more awareness, the life of many diabetics could become easier and healthier! 

(The writer is Director-Professor and Head of Department of Medicine, MLN Medical College, Allahabad)

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