Content area
Full text
Debbie Hicks and colleagues explain the correct injection technique for diabetes based on best practice
Summary
Surveys of people with diabetes have revealed that not only do they frequently use incorrect injection techniques but the primary healthcare professionals they deal with do not always know the correct technique either. This article uses the results of the recent pan-European injection technique survey to demonstrate the correct technique and the mistakes that people frequently make.
Keywords
Diabetes, insulin, injectable therapies, best practice
AS MANY as 2.75 million people in the UK have diabetes and this total is forecast to climb to four million by 2025 (Diabetes UK 2008). Diabetes treatment and complications cost the NHS approximately £1 million per hour or nearly £9 billion a year - approximately a tenth of the NHS budget (BBC News 2006). Around 800,000 people, 30 per cent of people with diabetes, use injectable therapies (Bohannon 1999). With the increase in the incidence of diabetes and the trend towards using injectable therapies earlier in the progression of the disease, this number will undoubtedly rise.
Insulin has been commercially available since the 1920s. Its discovery meant that people with type 1 diabetes survived, instead of enduring slow and painful deaths through starvation. Without insulin, glucose in the blood cannot enter cells to provide energy. Without glucose another source of energy is needed - fat. Unfortunately, when fat is metabolised, ketone bodies are released which are toxic and can cause ketosis and ketoacidosis, which are generally accompanied by weight loss. Ketoacidosis, which sees the blood become increasingly acidic, is still potentially fatal, especially in very young or older people. Insulin, therefore, is essential for life.
Since its discovery, insulin has been refined and developed to allow it to work in a predictable fashion (Figure 1). However, the absorption and action of insulin and other injected therapies can be reduced by poor injection technique.
Current practice
Insulin and the newer incretin mimetics, such as Exenatide and Liraglutide (also known as GLP-1 agonists), are expensive and highly advanced drugs. For them to work optimally, correct injection technique is essential. Unfortunately, injection technique tends not to be regularly reassessed - this can have dangerous consequences.
It is only in the past few years that there have...