Insulin injection technique

Thow, J. C., Johnson, A. B., Fulcher, G., and Home, P. D., 1990, Different absorption of isophane (NPH) insulin from subcutaneous and intramuscular sites suggests a need to reassess recommended insulin injection technique, Diabetic Med. 7 600-602. 

Localized redness, swelling, and itchingcausedby improper injection technique or allergy to cleansing solution or insulin Infrequent... 

Insulin species Injection technique Injected region... 

Insulin can induce local, painful lumps at injection sites. Sclerosing granulomata are occasionally seen (136) perhaps due to zinc (137). Such reactions are most commonly a consequence of an incorrect injection technique, generally the use of too short a needle or too superficial an injection. General edema (SEDA-11, 364) or abscesses (SEDA-7, 406) generated by insulin injections are extremely rare. 

For therapy of local lumps, extravasation, etc., one should first seek to improve the injection technique. Substitution with highly purified insulin is recommended. Injection with purified insulin into the affected area may speed up resorption of the lumps. Lipodystrophy or lipoa-trophy improve after switching to highly purified human or insulin lispro. Lipohypertrophy, on the other hand, often fails to respond to changes in the insulin regimen (161). Varying the injection site may help, but differences in absorption rate then have to be taken into account. 

Insulin-induced lipohypertrophy can cause reduced efficacy of insulin, which should prompt review of injection technique and injection sites (170). 

The American Diabetes Association has published revised guidelines on insulin administration, including storage of insulin, use and reuse of needles, alternatives to syringes, injection techniques, and patient management... 

Patients on long-term insulin therapy are usually trained to administer their own medication. In order to safely use insulin, it is important to provide adequate (refrigerated) storage of the preparation, to maintain sterile syringes, to accurately measure the dose and fill the syringe, and to use a proper injection technique. Patients should rotate the sites of administration (abdomen, upper thighs, upper arms, back, and buttocks) to avoid local damage from repeated injection. 

The observed precision is comparable to the values we previously reported for biosynthetic human insulin (16). It also is similar to independent results obtained using a totally automated system (2.9% RSD) and much better than that reported for manual injection (11.8% RSD), both using a hydrodynamic injection technique (21). Finally, the observed precision for the percent desamido, which is really an area ratio similar to what would be obtained by comparison to an internal standard, is excellent for the 10-nL or larger injections. Although the data are insufficient to make a definitive conclusion, it suggests that the observed error is comparable to that obtained from many chromatographic techniques. It also suggests that one of the predominant sources of error is imprecision in the injection volume. The error in injection volume was recently characterized (19). They also reported approximately 1-3% RSD in peak areas for vacuum injection of various compounds. 

Zinc is used in ointments and eye-lotions and is a constituent of different forms of insulin. In the former type of applications zinc oxide, zinc stearate and zinc undecanoate may be encountered in a variety of creams, ointments and pastes. Moody and Taylor [104] dissolved the residue from such samples after ether extraction (lg in 5 ml ether) in concentrated hydrochloric acid. After dilution, the determination can be completed at 213.9 nm in the air/acetylene flame where interferences are not normally encountered. Various analytical techniques for determining zinc in insulin injections have been critically compared [105] atomic absorption was preferred as being accurate, fast and precise. Spielhotz and Toralballa [106] reported a method capable of determining low levels of zinc in insulin. The sample (5 mg) was suspended in water (10 ml), 1 drop of 6M hydrochloric acid was added to effect dissolution. After making up to 50 ml the determination was completed using an air/acetylene flame. Alternatively protamine insulin solution (1 ml) may be diluted to 50 ml after the addition of 1 drop of acid. 

Type 1 diabetes is treated with insulin replacement therapy, usually by insulin injection or insulin pump, along with attention to dietary management and careful monitoring of blood glucose levels. Today most insulin is produced using genetic recombination techniques insulin analogues are a form of modified insulin with different onset-of-action times or duration-of-action times. 

The important thing is for the doctor to get to know well a range that will serve most patients. (For insulin regimens and injection techniques, see p. 691.)... 

Injection technique has pharmacokinetic consequences according to whether the insulin is delivered into the subcutaneous tissue or (inadvertently) into muscle. The introduction of a range of appropriate length needles and pen-shaped injectors has enabled patients to inject perpendicularly to the skin without risk of intramuscular injection. The absorption of insulin is as much as 50% more rapid from shallow i.m. injection. Clearly factors such as heat or exercise which alter skin or muscle blood flow can markedly alter the rate of insulin absorption. 

Cemea, S. Kidron, M. Wohlgelemter, J. Modi, P. Raz, I. Comparison of pharmacokinetic and pharmacodynamic properties of single-dose oral insulin spray and subcutaneous insulin injection in healthy subjects using the euglycemic clamp technique. Clin. Ther. 2004, 26 (12), 2084-2091. 

There is no doubt that insulin injections prolong the life of diabetics, but only the presence of a fully functioning pancreas can allow a diabetic to live a life free of the complications noted here. At present, pancreas transplants do not have a good track record. Only about 50% of the transplants are functioning after one year. It is hoped that improved transplantation techniques will be developed so that diabetics can live a normal life span, free of debilitating disease. 

Demonstrate how the patient or family members are to administer medication. For example, show the proper injection techniques if the patient requires insulin injections or the correct use of bronchodilator inhalers for asthma. Don t assume that they can administer the medication after seeing you do it. Make sure to have the patient and family members show you how they plan to give the medication. This is especially critical when medication is given using a syringe, topical dmgs, and inhalers. The patient and the caregiver must have visual acuity, manual dexterity, and the mental capacity to prepare and administer medication. 

Hildebrandt, P., Sestoft, L., and Nielson, S. L., 1983, The absorption of subcutaneously injected short-acting soluble insulin Influence of injection technique and concentration. Diabetes C(we6 459-462. 

The properties are very special in that the proteins attach to more acidic proteins. Before modern protein separation techniques became available, the protamines were used for purification of other proteins (Green and Hughes, 1955). The tight binding to other proteins was also utilised, and still is, for the introduction of insulin to diabetic patients (Hagedorn et al., 1936). It was in fact the protamine from salmon (salmin) that made insulin injection a success, in that it allowed for a slow release of insulin into the blood. This had previously been a problem. 

However, there are a number of other miscellaneous biological roles played by this complex. The [Co(NH3)6]3+ ion has been shown to inhibit the hammerhead ribozyme by displacing a Mn2+ ion from the active site.576 However, [Co(NH3)6]3+ does not inhibit ribonuclease H (RNase),577 topoisomerase I,578 or hairpin ribozyme,579 which require activation by Mg2+ ions. The conclusions from these studies were that an outer sphere complex formation between the enzyme and Mgaq2+ is occuring rather than specific coordination of the divalent ion to the protein. These results are in contrast to DNase I inhibition by the same hexaammine complex. Inhibition of glucose-induced insulin secretion from pancreatic cells by [Co(NH3)6]3+ has been found.580 Intracellular injection of [Co(NH3)6]3+ into a neurone has been found to cause characteristic changes to the structure of its mitochondria, and this offers a simple technique to label neuronal profiles for examination of their ultrastructures.581... 

Non-invasive insulin delivery is still experimental. The various methods (transdermal, nasal, lungs, oral) have been reviewed, with special attention to the various techniques and administration of inhaled insulin, which seems the most promising alternative to injection (266,267). 

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