pdci core kit 12 insulin injection technique dr. hendra zufri

7/23/2019 PDCI Core Kit 12 Insulin Injection Technique Dr. Hendra Zufri

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Curriculum(VitaeA.(Personal(Iden5ty

B.(Educa5on&(Training(

(

C.(Organiza5on(

Insulin Injection

Technique



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Interna5onal(Diabetes(Federa5on(Atlas,(2012(

Simpang Lima, Banda Aceh, 4 September 2015

Slide 4



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Interna5onal(Diabetes(Federa5on(Atlas,(2012

•Long term studies have provided conclusive

evidence than maintaining tight glycemiccontrol can delay the progression of

microvascular complication



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Glycaemic Variability as the enemy

•Sustained chronic hyperglycemia has

deleterious vascular consequences

•Glucose swings amplify the effect of

chronic hyperglycemia

Key Barriers to Insulin Initiation

Rubin RR et al. Diabetes Care 2006;29:1249 –55.

More than 50% of patients are very worried aboutstarting on Insulin

More than 50% of patients believe that starting onInsulin mean that they have failed to manage theirdisease

Only 20% believe thatInsulin can help themmanage their disease

More than 33% of HCPs postponeInsulin until “absolutely essential”

67% use Insulin as a threat for their patients



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“Good injection technique leads to good

blood glucose control which is vital in

preventing the long term complications of

diabetes”

Variability in insulin action : Why ??

• Inter individual variability or intraindividual

variability

• Exogenous Factor of variation

• Insulin preparation

• Injection conditions

Endogeneous Factor

• Insulin sendiri : diffusion of insulin or the

interaction between insulin and its receptor



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Factors of glycemic variability in

insulin-treated patients

•Injection technique

•Site of injection

•Site and depth of injection

• Injection into lipohyperthrophy

So...

•The Key to achieving optimal glycemic

control is the patient adherence totreatment regimen in diabetes

management

•Good Injection practices should be

adressed at every patient visit



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Helping Patients With

Injectable Therapy

• Educate patient on proper use and on new

devices with smaller needles.

• Demonstrate self-injection in the office

with patient.

• Ask patient if he or she is willing to try an

injectable therapy for a short period oftime before making a final decision.

The History of Insulin

1921 : Insulin Invented

s/d 1983 : Animal Insulin Era

1983 : Human Insulin Era

1999 : Analog insulin



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1926

• First syringe just for insulin injection

The Proper Use of Pen

• Pens are for a single patients and should never be

shared

• Needle should be disposed of immediately after use

• Pen needle should be used only once

• Patients should count slowly to 10 before withdrawing

the needle



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Injecting Process

• Injection should only into the subcutaneous

• Avoid insertion into intramuscular area

• The site should be inspected by the patient prior to

injection

• Change sites if the current one shows signs of

lipohypertrophy, inflammation, edema or infection

• Most insulin injection are not painful

Needle Length

• The goal of injections with

insulin is to reliably deliver the

medication into the SC space,without leakage and with

minimal discomfort.

• Choosing an appropriate

needle length is crucial for

accomlishing this goal.



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Needle Evolution

Needle length for patients



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Needle Length

• Initial therapy should begin with the shorter lengths

• Injection with shorter needles (4,5,6 mm) should be

given in adults at 900 to the skin surfaces

• Skin fold or injecting at 450 should be considered for

injections into the limbs or slim abdomen

Blood vessels penetrate each

layer of skin



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But BLOOD FLOW differs considerably from

one layer to another

• Dermis : small but swift flow and highly

variable

• Subcutaneous : slow flow and very stable

• Muscle : large, swift flow and highly

Injection Sites



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Adults

Studies have shown that IM Injections occur

in 12 -34 % of injections depending on :

Injection site

Body habitus of patient

Length of needle

Use of pinch or not

How long pinch held and when realesed

Thickness of SC in mm



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Injection Site Rotation

Pen Injection Technique

In ject ion Techniques



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Injecting high doses of Insulin

(> 40 Unit)

• Leave the needle inserted in the skin a longer

time at the end of the injection

• Split the dose into two consecutive injections

• The maximum volume requiring a split of the

dose is not universally agreed

How is the correct Pinch Up?



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Role of Rising a Skin Folds (pinching)

• It is used when the presumptive distance from skin

surface to the muscle is less than the length of the

needle

• Each injection site should be examined individually

• All patients should be taught the correct technique for

lifting a skin fold from the onset of insulin therapy

Angle of Needle with a pinch



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Pregnant Women

1. Should give all injection using raised skin fold

2. Avoid around umbilicus during 3th semester

SUMMARY



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• Store insulin in current use at room temperature(max 1 month and within expiry date )

• Store unopenes insulin in an area of therefrigerator when freezing in unlikely to occur

• Cloudu insulin must be gently rolled and /or tipped( not shaken) for 20 cycles until the solution

becomes milky white

Insulin Storage and Suspension

Efek Samping Penyuntikan Insulin

LYPODYSTROPHY

&

LYPOHYPERTROPHY



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Lipohypertrophy

• Sites should be inspected by the HCP at very visit

• Making two ink marks at opposites edges of the

lipohypertrophy• Patients should not inject into areas of lipohypersthrophy

until the abnormal tissue returns to normal

• Switching injections from lipohyperthropy to normal tissue

• The best current presentative and therapeutic strategies

for lipohypertrophy

Patients feels less pain when injecting in the lipohypertrophy



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Slide 39

• Keep insulin in use at room temperature

• If using alcohol, injecting only when the alcohol has

fully dried

• Avoid injecting at hair roots

• Using shorter length and smaller dismeter needle

• Using new needle at each injection

Tips of Making Injection Less

Painful



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Re-suspension required for Pre-m ix

and Intermediate act ing Insul in

Gulung Pena Insulin

diantara kedua telapak

tangan sampai dengan 10 x

Gerakkan pena insulin

keatas dan ke bawah

sebanyak 10 x

&



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Remov ing the Outer Cap


Ensu re that no air bubb les are present in

the pen



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Needle length choice and injection

technique

Re-use needle



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Coincidence between lipohypertrophies and

multiple reuse of pen needles

The increase of the risk for lipohypertrophies is significant

the more frequent pen needles are reused



Slide49

Thank You For Your

Attention

My Family...

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pdci core kit 12 insulin injection technique dr. hendra zufri

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