Journal List > J Korean Diabetes > v.17(4) > 1055034

Gu: New Insulin Injection Recommendations


Based on the 4th Injection Technique Questionnaire results, new insulin injection technique recommendations were announced at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, on October 23 and 24, 2015, in which 183 physicians, nurses, educators, and allied healthcare professionals from 54 countries attended. Through these new recommendations, we hope to identify and localize the new insulin injection technique recommendations that could be applicable in local clinical settings. It is recommended to use a pen needle with a wider inner diameter when its gauge remains the same. Also, recommended injection sites such as the abdomen, upper arms, thighs, and buttocks are well described based on anatomical landmarks. The insulin absorption rate is the fastest at the abdomen, upper arms, thighs and buttocks in the case of human insulin; however, there is no difference in absorption rate in the case of insulin analog, regardless of site selection. Also, air-shooting is not necessary if drops are observed as soon as the needle is attached to the pen. Diabetes educators should be familiar with new insulin injection technique recommendations, not only to keep themselves updated with new knowledge, but also so they can educate patients to assure patient safety and achieve better outcomes.


1. FITTER International Congress. October 23–25, 2015. Rome, Italy. BD website. Available from:. (accessed 2016 Jun 8).
2. Hong SH, Kim MJ, Noh SG, Suh DW, Youn SJ, Lee KW, Lee HC, Chung YS, Chung HR, Kwon HS, Cha BY, Son HY, Yoon KH. A study on resistance in type 2 diabetic patient against commencement of insulin treatment. Korean Diabetes J. 2008; 32:269–79.
3. Frid AH, Kreugel G, Grassi G, Halimi S, Hicks D, Hirsch L, Smith MJ, Wellhoener R, Bode BW, Hirsch IB, Kalra S, Ji L, Strauss KW. New insulin delivery recommendations. Mayo Clin Proceedings. 2016; 91:1231–55.
4. Aronson R. The role of comfort and discomfort in insulin therapy. Diabetes Technol Ther. 2012; 14:741–7.
5. Anderson G, Meyer D, Herrman CE, Sheppard C, Murray R, Fox EJ, Mathena J, Conner J, Buck PO. Tolerability and safety of novel half milliliter formulation of glatiramer acetate for subcutaneous injection: an open-label, multicenter, randomized comparative study. J Neurol. 2010; 257:1917–23.
6. American Association of Diabetes Educators. Insulin pump therapy: best practices in choosing and using infusion devices. Chicago: American Association of Diabetes Educators;2011.
7. Lumber T. Tips for site rotation. When it comes to insulin, where you inject is just as important as how much and when. Diabetes Forecast. 2004; 57:68–70.
8. Blanco M, Hernández MT, Strauss KW, Amaya M. Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes. Diabetes Metab. 2013; 39:445–53.
9. Birkebaek NH, Solvig J, Hansen B, Jorgensen C, Smedegaard J, Christiansen JS. A 4-mm needle reduces the risk of intramuscular injections without increasing backflow to skin surface in lean diabetic children and adults. Diabetes Care. 2008; 31:e65.
10. Lo Presti D, Ingegnosi C, Strauss K. Skin and subcutaneous thickness at injecting sites in children with diabetes: ultrasound findings and injecting recommendations for giving injection. Pediatric Diabetes. 2012; 13:525–33.
11. Frid A. Fat thickness and injectable therapy administration, what do we know? Infusystems Int. 2006; 5:17–9.
12. Kaiser P, Maxeiner S, Weise A, Nolden F, Borck A, Forst T, Pfützner A. Assessment of the mixing efficiency of neutral protamine Hagedorn cartridges. J Diabetes Sci Technol. 2010; 4:652–7.
13. Strauss K. Conversation with: Jessie S. 2016 Feb 22. English.
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