title: Subcutaneous or intramuscular injections of insulin in children. Are we injecting where we think we are?
abstract: OBJECTIVE
  This study was designed to assess the insulin injection location in a group of children who had their injection according to their daily practice, thought to lead to subcutaneous injections.
  
  
  METHODS
  The location of the insulin deposit at the injection site was visualized using an ultrasound device.
  
  
  RESULTS
  The exact insulin injection location could be localized, and 18 of 59 injections (30.5%) (one injection for each child) were in the intramuscular tissue. Of the children who had intramuscular injection, 15 of 18 were boys. The children who had an intramuscular injection had a significantly lower percentile of BMI (mean +/- SE: 47 +/- 8 vs. 72 +/- 4, P = 0.004), lower distance from skin surface to muscle fascia without a skinfold (5.6 +/- 0.6 vs. 11 +/- 0.7 mm, P < 0.0001), and a lower distance from skin surface to muscle fascia with a skinfold (8.1 +/- 0.9 vs. 15.9 +/- 0.8 mm, P < 0.0001) than children who had a subcutaneous insulin injection.
  
  
  CONCLUSIONS
  We identified a group of children at risk for intramuscular insulin injections and that may deserve specific injection technique and advice.
authors.affiliation: Department of Pediatric Endocrinology and Diabetology, Robert Debré University Hospital, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Polak
authors.forename: M
authors.initials: M
authors.lastname: Beregszaszi
authors.forename: N
authors.initials: N
authors.lastname: Belarbi
authors.forename: K
authors.initials: K
authors.lastname: Benali
authors.forename: M
authors.initials: M
authors.lastname: Hassan
authors.forename: P
authors.initials: P
authors.lastname: Czernichow
authors.forename: N
authors.initials: N
authors.lastname: Tubiana-Rufi
mesh_terms: D000704:Analysis of Variance; D015992:Body Mass Index; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007273:Injections, Intramuscular; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging; D010290:Parents; D012648:Self Care; D012867:Skin / Q000000981:diagnostic imaging; D012885:Skinfold Thickness; D014463:Ultrasonography
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin