title: Defining the ideal injection techniques when using 5-mm needles in children and adults.
abstract: OBJECTIVE
  We aimed to establish the ideal injection techniques using 5-mm needles to reliably inject insulin into the subcutaneous fat in both children and adults and to quantify the associated pain and leakage of the test medium.
  
  
  METHODS
  A total of 259 subjects (122 children/adolescents and 137 adults) were injected with sterile air corresponding to 20 IU insulin (200 microl) with 32-G 5-mm needles at 90 degrees or 45 degrees , in the abdomen and thigh, and with or without a pinched skin fold. Injection depth was assessed via ultrasonography. Subjects rated pain on a visual analog scale. Test medium injections into the abdomen and thigh (0.2-0.6 ml) were also administered to assess injection leakage.
  
  
  RESULTS
  Among children, 5.5% of injections were intramuscular (IM) and 0.5% were intradermal, while in adults, the incidence was 1.3 and 0.6%, respectively. The frequency of IM injections was greater in boys and negligible among adult women. Subcutaneous fat thickness was the primary predictor of the likelihood of IM injections (P < 0.001). A third of all patients reported experiencing no pain during insulin injection, with children/adolescents experiencing considerably more discomfort than adults. Some leakage of medium was observed, but was unrelated to injection volume and was generally minimal.
  
  
  CONCLUSIONS
  5-mm needles are reliably inserted into subcutaneous fat in both adults and children. These needles were associated with reduced pain and minimal leakage. We recommend an angled injection with a pinched skin fold for children, while in adults, the technique should be left to patient preference.
authors.affiliation: Liggins Institute, University of Auckland, Auckland, New Zealand. p.hofman@auckland.ac.nz
authors.forename: Paul Leslie
authors.initials: PL
authors.lastname: Hofman
authors.forename: José Guilherme Behrensdorf
authors.initials: JG
authors.lastname: Derraik
authors.forename: Teresa Elizabeth
authors.initials: TE
authors.lastname: Pinto
authors.forename: Sheryl
authors.initials: S
authors.lastname: Tregurtha
authors.forename: Ann
authors.initials: A
authors.lastname: Faherty
authors.forename: Jane Michele
authors.initials: JM
authors.lastname: Peart
authors.forename: Paul Leslie
authors.initials: PL
authors.lastname: Drury
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Robinson
authors.forename: Ramin
authors.initials: R
authors.lastname: Tehranchi
authors.forename: Morten
authors.initials: M
authors.lastname: Donsmark
authors.forename: Wayne Stephen
authors.initials: WS
authors.lastname: Cutfield
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D007273:Injections, Intramuscular / Q000009:adverse effects; D007279:Injections, Subcutaneous / Q000009:adverse effects; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009339:Needles; D010146:Pain / Q000209:etiology; D055815:Young Adult