title: Improvement of Insulin Injection Technique: Examination of Current Issues and Recommendations.
abstract: Correct insulin injection technique is a crucial aspect of diabetes management. The purpose of this article is (1) to outline the medical literature, including patient-based studies and surveys, surrounding the type of issues and problems that patients encounter with injectable insulin therapy and the degree to which correct insulin technique is being applied and (2) to review the latest recommendations for insulin injection technique and discuss the key aspects that diabetes educators and other health care professionals should be communicating to their patients to ensure that injection technique is optimized.
  
  
  
  Examination of the literature and multiple patient surveys demonstrates that patients continue to have many issues with insulin injection technique, highlighting the pressing need for effective patient education. In addition, many patients are not using insulin pen devices correctly. Widespread lack of injection site rotation and reuse of needles have resulted in high rates of lipohypertrophy. Lipohypertrophy has in turn been associated with significantly increased levels of unexplained hypoglycemia and glycemic variability and significantly increased insulin costs. By providing clear, evidence-based consensus recommendations, initiatives such as the Forum for Injection Technique are helping to address these issues but will be successful only if concerted efforts in patient education and reeducation are made to ensure that these recommendations are implemented consistently. This should involve all stakeholders in insulin therapy-particularly diabetes educators, who are at the forefront of patient education.
authors.affiliation: Department of Internal Medicine, Yale Diabetes Center, Yale School of Medicine, New Haven, Connecticut (Ms Spollett)
authors.forename: Geralyn
authors.initials: G
authors.lastname: Spollett
authors.affiliation: Department of Medicine, Division of Endocrinology, University of California-San Diego, San Diego, California (Dr Edelman)
authors.forename: Steven V
authors.initials: SV
authors.lastname: Edelman
authors.affiliation: Hospital Español de México, Mexico City, Mexico (Dr Mehner)
authors.forename: Patricia
authors.initials: P
authors.lastname: Mehner
authors.affiliation: Special Doctor's Office in Endocrinology and Diabetes, Gunzenhausen, Germany (Ms Walter)
authors.forename: Claudia
authors.initials: C
authors.lastname: Walter
authors.affiliation: Department of Diabetology and Endocrinology, Sud-Francilien Hospital, Corbeil-Essonnes, Paris-Sud University, France (Dr Penfornis)
authors.forename: Alfred
authors.initials: A
authors.lastname: Penfornis
mesh_terms: D001786:Blood Glucose; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D055317:Evidence-Based Practice / Q000193:education; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007267:Injections; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D009339:Needles; D010353:Patient Education as Topic; D012648:Self Care
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin