Evidence for Questions by Diabetes Educators When Teaching Insulin Injection in Clinical Practice

Jeong Rim Lee

doi:10.4093/jkd.2017.18.2.109

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Lee: Evidence for Questions by Diabetes Educators When Teaching Insulin Injection in Clinical Practice

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The Journal of Korean Diabetes 2017; 18(2): 109-116.

Published online: 29 June 2017

DOI: https://doi.org/10.4093/jkd.2017.18.2.109

Evidence for Questions by Diabetes Educators When Teaching Insulin Injection in Clinical Practice

Jeong Rim Lee

Department of Nursing, Out-patient Nursing 1 Team, Asan Medical Center, Seoul, Korea.

Corresponding author: Jeong Rim Lee. Department of Nursing, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea, jrlee@amc.seoul.kr

Received 4 May 2017 Accepted 8 May 2017

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

International injection recommendations for patients with diabetes have recently been published and have identified specific recommendations for health care professionals. The purpose of this article is to provide evidence-based insight based in relevant papers that provide useful information for the questions that educators in the field of insulin injection training may have. Research regarding skin and subcutaneous thickness reveals that shorter needles may be appropriate for the majority of patients regardless of body mass index. With respect to reusing needles, further research is needed to provide evidence that this is safe. Periodic reassessment of injection techniques, including suspension of cloudy insulin and inspection of injection sites for lipohypertrophy, is a critical aspect of the role of the diabetes educator. Education of diabetic patients should be conducted throughout their lives. It will be necessary to continually review each patient's social, economic, and physical needs as they change over time and modify their care and education needs accordingly.

Keywords: Diabetes mellitus, Health educators, Injection, Patient education, Subcutaneous

References

1. Korea Diabetes Association. Treatment guideline for dabetes. 5th ed. Seoul: Gold Planning and Development;2015. p. 50.

2. Gu MJ. [New insulin injection recommendations]. J Korean Diabetes. 2016; 17:261–265.

3. Gibney MA, Arce CH, Byron KJ, Hirsch LJ. Skin and subcutaneous adipose layer thickness in adults with diabetes at sites used for insulin injections: implications for needle length recommendations. Curr Med Res Opin. 2010; 26:1519–1530.

4. Hirsch LJ, Gibney MA, Li L, Bérubé J. Glycemic control, reported pain and leakage with a 4 mm × 32 G pen needle in obese and non-obese adults with diabetes: a post hoc analysis. Curr Med Res Opin. 2012; 28:1305–1311.

5. Hirsch L, Byron K, Gibney M. Intramuscular risk at insulin injection sites--measurement of the distance from skin to muscle and rationale for shorter-length needles for subcutaneous insulin therapy. Diabetes Technol Ther. 2014; 16:867–873.

6. Frid A, Hirsch L, Gaspar R, Hicks D, Kreugel G, Liersch J, Letondeur C, Sauvanet JP, Tubiana-Rufi N, Strauss K. Scientific Advisory Board for the Third Injection Technique Workshop. New injection recommendations for patients with diabetes. Diabetes Metab. 2010; 36:Suppl 2. S3–18.

7. Zabaleta-Del-Olmo E, Vlacho B, Jodar-Fernández L, Urpí-Fernández AM, Lumillo-Gutiérrez I, Agudo-Ugena J, Morros-Pedrós R, Violán C. Safety of the reuse of needles for subcutaneous insulin injection: A systematic review and meta-analysis. Int J Nurs Stud. 2016; 60:121–132.

8. Frid AH, Hirsch LJ, Menchior AR, Morel DR, Strauss KW. Worldwide injection technique questionnaire study: injecting complications and the role of the professional. Mayo Clin Proc. 2016; 91:1224–1230.

9. Blanco M, Hernández MT, Strauss KW, Amaya M. Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes. Diabetes Metab. 2013; 39:445–453.

10. Strauss K. An unexpected hazard of insulin injection. Pract Diab Int. 2002; 19:63.

11. Korean Association Diabetes Nurse Educators. Insulin injection technique guidelines for diabetes educators. 2nd ed. Seoul: Korean Association Diabetes;2017. p. 51–59. Chapter 4, Insulin injection site.

12. Borders LM, Bingham PR, Riddle MC. Traditional insulin-use practices and the incidence of bacterial contamination and infection. Diabetes Care. 1984; 7:121–127.

13. Fleming DR, Jacober SJ, Vandenberg MA, Fitzgerald JT, Grunberger G. The safety of injecting insulin through clothing. Diabetes Care. 1997; 20:244–247.

14. Saltiel-Berzin R, Cypress M, Gibney M. Translating the research in insulin injection technique: implications for practice. Diabetes Educ. 2012; 38:635–643.

15. Müller N, Frank T, Kloos C, Lehmann T, Wolf G, Müller UA. Randomized crossover study to examine the necessity of an injection-to-meal interval in patients with type 2 diabetes and human insulin. Diabetes Care. 2013; 36:1865–1869.

16. Ohta A, Arai K, Nishine A, Sada Y, Kato H, Fukuda H, Asai S, Nagai Y, Katabami T, Tanaka Y. Comparison of daily glucose excursion by continuous glucose monitoring between type 2 diabetic patients receiving preprandial insulin aspart or postprandial insulin glulisine. Endocr J. 2013; 60:173–177.

17. Pledger J, Hicks D, Kirkland F, Down S. Importance of injection techinque in diabetes. J Diabetes Nurs. 2012; 16:160–165.

18. Bruttomesso D, Costa S, Dal Pos M, Crazzolara D, Realdi G, Tiengo A, Baritussio A, Gagnayre R. Educating diabetic patients about insulin use: changes over time in certainty and correctness of knowledge. Diabetes Metab. 2006; 32:256–261.

19. De Coninck C, Frid A, Gaspar R, Hicks D, Hirsch L, Kreugel G, Liersch J, Letondeur C, Sauvanet JP, Tubiana N, Strauss K. Results and analysis of the 2008-2009 Insulin Injection Technique Questionnaire survey. J Diabetes. 2010; 2:168–179.

20. Scain SF, Friedman R, Gross JL. A structured educational program improves metabolic control in patients with type 2 diabetes: a randomized controlled trial. Diabetes Educ. 2009; 35:603–611.

21. Brown A, Steel JM, Duncan C, Duncan A, McBain AM. An assessment of the adequacy of suspension of insulin in pen injectors. Diabet Med. 2004; 21:604–608.

22. Jehle PM, Micheler C, Jehle DR, Breitig D, Boehm BO. Inadequate suspension of neutral protamine Hagendorn (NPH) insulin in pens. Lancet. 1999; 354:1604–1607.

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