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Subcutaneous or intramuscular insulin injections
C P Smith1, M A Sargent, B P Wilson
1Department of Paediatrics, Booth Hall Children's Hospital, Blackley, Manchester.
Insights
Diabetic children may inject insulin into muscle, not just under the skin. Ultrasonography revealed injection depth issues in boys and girls, potentially leading to intramuscular or intraperitoneal insulin delivery.
Area of Science:
- Pediatric Endocrinology
- Medical Imaging
- Diabetes Management
Background:
- Subcutaneous insulin injection is standard for pediatric diabetes management.
- Accurate subcutaneous delivery is crucial for glycemic control and preventing complications.
- Understanding injection site anatomy in children is vital for safe insulin administration.
Purpose of the Study:
- To investigate the risk of intramuscular or intraperitoneal insulin injections in children with diabetes.
- To assess the relationship between patient demographics, injection sites, and needle depth.
Main Methods:
- Ultrasonography was used to measure skin-to-fascia distances at common insulin injection sites in 32 children (aged 4.3-17.9 years).
- Measurements were taken at the outer arm, thigh, abdomen, buttock, and calf.
- Injection angles and skinfold techniques were also analyzed.
Main Results:
- Injection site distances varied significantly between boys and girls.
- Most boys, and some girls, were at risk of intramuscular or intraperitoneal delivery with a 12.5 mm needle at a 90-degree angle.
- Raising a skinfold increased the subcutaneous distance by an average of 19%.
Conclusions:
- Many children, particularly boys, may inadvertently inject insulin intramuscularly or intraperitoneally.
- Current insulin injection techniques and needle lengths may not be optimal for all pediatric patients.
- Further research and technique adjustments are needed to ensure safe and effective insulin delivery in children.
Abstract:
To find out whether diabetic children may inject their insulin intramuscularly rather than subcutaneously, a random sample of 32 patients aged 4.3-17.9 (median 11.3) years was studied. Distance from skin to muscle fascia was measured by ultrasonography at standard injection sites on the outer arm, anterior and lateral thigh, abdomen, buttock, and calf. Distances were greater in girls (n = 15) than in boys (n = 17). Whereas in most boys the distances were less than the length of the needle (12.5 mm) at all sites except the buttock, in most girls, the distances were greater than 12.5 mm except over the calf. Over the fascial plane just lateral to the rectus muscle the distance from skin to peritoneum was less than 12.5 mm in 14 of the 17 boys and one of the 15 girls. Twenty five of the 32 children injected at an angle of 90 degrees, and 24 children raised a skinfold before injecting. By raising a skinfold over the anterior thigh, the distance from skin to muscle fascia was increased by 19% (range 0-38%). We conclude that most boys and some girls who use the perpendicular injection technique may often inject insulin into muscle, and perhaps on occasions into the peritoneal cavity.