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Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications
Sanjay Kalra1, Laurence J Hirsch2, Anders Frid3
1Bharti Hospital & B.R.I.D.E., Karnal, Haryana, India.
Insights
Pediatric patients with diabetes often experience lipohypertrophy and hypoglycemia due to improper insulin injection techniques. Improving injection practices, including needle length and site rotation, is crucial for better diabetes management in children.
Area of Science:
- Pediatric Endocrinology
- Diabetes Management
- Clinical Nursing
Background:
- A survey of 13,289 patients identified 898 pediatric patients (≤18 years) for analysis.
- Pediatric patients were categorized into three age groups: 0-6 years (G1), 7-13 years (G2), and 14-18 years (G3).
Purpose of the Study:
- To evaluate insulin injection techniques and associated complications in pediatric patients.
- To identify factors contributing to lipohypertrophy, hypoglycemia, and glucose variability in children with diabetes.
Main Methods:
- Utilized data from the 2015 Insulin Injection Technique Questionnaire.
- Assessed injection technique through questionnaires and nurse evaluations across three pediatric age groups.
- Analyzed prevalence of lipohypertrophy, hypoglycemia, glucose variability, needle usage, and injection training.
Main Results:
- High rates of lipohypertrophy (41.3-47.3%) were observed across all pediatric age groups.
- Unexpected hypoglycemia (23.8-48.1%) and glucose variability (45.9-61.0%) were common and linked to lipohypertrophy.
- Inappropriate needle lengths (up to 61.5%), needle reuse (up to 32.5%), and lack of recent injection training (up to 26.8%) were prevalent.
Conclusions:
- Recommend 4-mm pen needles or 6-mm syringes (at 45° angle) for pediatric patients.
- Advise patients ≤6 years to inject into a raised skin fold.
- Emphasize site rotation and single needle use for all patients to prevent lipohypertrophy.
Introduction:
The 2015 Insulin Injection Technique Questionnaire survey involving 13,289 patients included 898 (6.8%) patients in the pediatric age range (≤ 18 years).
Methods:
The younger patients included in the questionnaire survey were grouped according to age: Group 1 (G1), 0-6 years, n = 85; Group 2(G2), 7-13, n = 423; Group 3 (G3), 14-18, n = 390. The injection technique was evaluated by means of a questionnaire and nurse assessment.
Results:
Nurses found lipohypertrophy at injection sites in 41.3, 45.2, and 47.3% of patients in G1, G2, and G3, respectively. Unexpected hypoglycemia was common, ranging from 23.8 to 48.1% of patients, and glucose variability was even more common (61.0% in G1, 45.9% in G2, and 52.5% in G3); both conditions were associated with lipohypertrophy. While increasing numbers of patients were using the recommended 4-mm needles, large percentages still used longer ones (33.3% in G1, 45.9% in G2, and 61.5% in G3). The reuse of needles was also common, ranging from 21.1 to 32.5% in the three age groups. Excessive reuse, defined as using a single needle more than five times, was reported by 9.4-21.8% of patients in the three age group. The percentages of patients who had not received any injection training in the last 12 months ranged from 21.2 to 26.8% in the three groups.
Conclusion:
Implications of our study are as follows: (1) pediatric patients should use 4-mm pen needles or 6-mm syringes (inserted at a 45° angle); (2) patients aged ≤ 6 years should always inject into a raised skin fold regardless of which device is used; (3) all patients should rotate sites and use needles only once to avoid lipohypertrophy.
Funding:
Becton-Dickinson (BD) diabetes care.
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