A Comprehensive Guide to Safe and Effective Insulin Injection Techniques for Diabetic Patients

Presently, all insulin injection medications utilized by diabetic individuals in domestic settings necessitate subcutaneous administration. Employing a specialized injection apparatus, the medication is introduced into the subcutaneous adipose tissue, manifesting hypoglycemic effects over a specified duration.

Prominent locales for insulin administration in diabetic subjects predominantly encompass the bilateral abdominal region, situated 2.5 cm distant from the umbilicus, the upper one-third segment of the anterolateral aspects of both thighs, the upper lateral aspects of the bilateral buttocks, and the middle one-third of the lateral upper arms. These regions are amenable to subcutaneous injection.

Due to its procedural convenience, the abdominal region emerges as the favored injection site for numerous diabetic patients. Succinctly stated, by placing one’s fist on the navel, subcutaneous injections can be executed bilaterally on either side of the abdomen within a singular maneuver.

Which injection devices are conventionally employed?

Predominantly, needle injection pens, needleless syringes, and insulin pumps constitute the most frequently utilized injection implements for diabetic patients. Selection among these options is contingent upon individual circumstances after consultation with diabetes specialists and nurses.

For individuals utilizing a needle injection pen, an accompanying injection needle is often requisite. Presently, needle lengths range from a minimum of 4 mm to a maximum of 8 mm, with shorter needles generally regarded as safer. Given the average skin thickness of Chinese adults approximating 2 mm, 4 mm or 5 mm needles are generally suitable for vertical injection. Skin pinching is warranted in regions with diminished fat. Notably, for young children and slender adults, a 4 mm needle is recommended, necessitating skin pinching during injection.

Do absorption rates of drugs at diverse injection sites remain uniform?

The absorption kinetics of insulin vary across different anatomical locales. Generally, the abdomen exhibits the swiftest absorption, rendering it the preferred site for basal insulin injection. Short-acting insulin is advocated for abdominal injection initially. For premixed insulin formulations comprising a proportion of short-acting insulin, abdominal injection is recommended before breakfast, while buttock or thigh injection is suggested before dinner to mitigate nocturnal hypoglycemia risks. However, ultra-short-acting insulin analogs and glucagon-like peptide-1 receptor agonists exhibit unaltered absorption rates irrespective of the injection site, affording flexibility within the aforementioned range for subcutaneous injection.

What complications may arise in connection with injections?

● Subcutaneous fat hyperplasia
Thickening and sclerosis-like alterations in subcutaneous tissue at the injection site are primarily associated with prolonged insulin use, failure to rotate injection sites, and repetitive use of injection needles. As exemplified by the aforementioned diabetic individual, Xiao Wang, the “bulging mass” encircling the umbilicus typifies subcutaneous fat hyperplasia. If such hyperplasia manifests, injection at the implicated site should be promptly discontinued. Failure to do so may lead to uneven insulin distribution in subcutaneous tissue, potentially causing delayed absorption in certain areas and expedited absorption in others. Typically, fat hyperplasia resolves or diminishes following cessation of injections.

Continued injection into a region afflicted by fat hyperplasia may result in gradual desensitization of nerve endings, diminishing local pain perception. Nonetheless, normal insulin absorption is impeded, resulting in inexplicable blood sugar fluctuations. Certain diabetic individuals noted persistent hyperglycemia, prompting unauthorized increases in insulin dosage and subsequent severe hypoglycemic events.

● Lipoatrophy
Diminished fat cell count precipitates varying degrees of concavity in the skin, predominantly attributable to local immune responses. In the event of a depression at the injection site, immediate cessation of injections in the affected area, site alteration, and prompt consultation with an endocrinologist are imperative. Prolonged injection into a depressed region exacerbates local immune responses, amplifying fat cell loss. Moreover, inadvertent muscle layer injection may ensue, culminating in rapid insulin absorption, painful injections, and ensuing blood sugar fluctuations.

● Pain
The majority of hypoglycemic drug injections typically elicit negligible acute pain. However, recurrent unexplained sharp pain may be linked to common factors, including excessive needle length or incorrect skin pinching, resulting in fascial and muscular needle-tip injury. While such instances are sporadic and generally inconsequential, adopting correct injection techniques, selecting smaller, finer needles, eschewing needle reuse, and overcoming injection-related apprehension can collectively mitigate pain.

● Bleeding and Bruising
Hypodermic injection needles are typically diminutive. Applying pressure to the injection site for approximately 10 seconds post-injection minimizes the likelihood of skin bleeding or bruising. In rare instances, the needle may puncture a subcutaneous blood vessel, prompting minor bleeding. In such cases, extending the pressure duration until bleeding ceases suffices.

Individuals using anticoagulant medications or exhibiting abnormal coagulation function should tailor the compression duration based on individual conditions.

Adherence to standardized hypoglycemic drug injection protocols is pivotal to therapeutic efficacy. Optimal selection of injection devices, precise site targeting, and systematic rotation of injection sites not only forestall injection-related complications but also foster enhanced effectiveness in diabetes management.

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