To assist healthcare practitioners in their clinical practice, the Forum for Injection Technique (FIT) India has released the first ever evidence based Indian recommendations for best practice in insulin injection technique for people living with diabetes.

Experts say that the recommendations is the need of the hour as complications of incorrect injection practices often go unnoticed. Several factors including regular inspection of injection sites, preventing reuse of needle, correct site rotation, influence the success of insulin injection therapy.

Recommendations were released on the occasion of FIT Insulin Injection Day in Mumbai recently to commemorate the 93rd anniversary of first successful insulin administration on 11th January 1921, at Toronto General Hospital, Canada. The focus of the event was to combat Psychological Insulin Resistance (PIR) or resistance to initiating insulin therapy.

Highlighting on the need to adopt correct injection technique, Dr H B Chandalia, director, endocrinology, diabetes and metabolism, Jaslok Hospital said, “With only about 3 million people injecting insulin out of 67 million who live with diabetes, India has low rates of insulinisation. This is a road block in the optimal management of diabetes. Patients fear initiating insulin because of fear of needles and a sense of life-long dependence on Insulin. Also, many clinicians hesitate to put their patients on insulin therapy as they apprehend losing their patient‘s confidence."

Recommendations which will be distributed to healthcare professionals involved in injectable therapy for diabetes in India has been framed by 76 leading experts in India and 6 from South Asian countries. FIT is an autonomous organisation which supports people with diabetes using injectable therapies to achieve the best possible health outcomes that can be influenced by correct injection technique. The development of FIT and the subsequent India recommendations for injection technique have been supported by prominent medical technology firm Becton, Dickinson & Co. (BD India).

On this occasion, doctors from various hospitals including Jaslok Hospital, Nair Charitable Hospital, Cumballa Hill Hospital and Advisory Board members of Forum for Injection Technique (FIT) provided tips on overcoming needle phobia for insulin injection dependent patients.

As per the new recommendations, special emphasis is to be given to counter complications arising out of incorrect usage of injections and usage in special groups like pregnant women and people with weak immunity. In pregnant women, injections should be given in the abdomen using a raised skin-fold. In the first trimester women should be reassured that no change in insulin site or technique is needed. In the second trimester lateral parts of the abdomen can be used to inject insulin, staying away from the skin overlying the foetus. In the third trimester, insulin can be injected over the abdomen while ensuring the skin fold is properly raised. Apprehensive patients may use the thigh or upper arm to inject themselves.

The FIT recommendations also suggest that correct injection technique can help protect against lipohypertrophy (LH), unexplained hypoglycemia (low blood sugar) and blood glucose variation. Shorter needles can provide safety from injecting into muscle, as an insulin injection in the muscle may lead to hypoglycemia.

Dr Salomee Benjamin, Chief medical nutritionist Nair Charitable Hospital, Mumbai said, "Association of Diabetes Educators (ADE) is an organisation of healthcare professionals working in the field of diabetes with a vision to build a strong professional body of diabetes educators par excellence in India and to provide a platform through which, benefit to individuals with diabetes is conveyed.

The electronic Diabetes Educators Course (eDEC) is available to graduates in nutrition, nursing, pharma, occupational and physiotherapy (eg- BSc Nutrition, BSc Nursing, B Pharm, Bachelors of OT, Bachelors in PT). Additionally, these students should be working for a 3 months period at one of the centers recognized by Help Defeat Diabetes Trust (HDDT) under a recognized mentor. It is a 6 month course, punctuated by continuous self-assessment test and one final test taken on-line under the supervision of their mentor.

Upon successfully passing the test, a certificate of training by Dr Chandalia's Diabetes Endocrine Nutrition Management and Research Centre (DENMARC) and HDDT is issued. ADE plans to collaborate with public, private and government organisations towards policy making and advocacy to improve diabetes care in India."

The success of insulin injection therapy and the adherence to it depends on several factors such as a smooth insulin initiation process with counselling that alleviates the fear of needles, the insulin regime, length of needle and the method of administration, For example, it is always preferable to use a new needle for each injection, choose shorter needles with a smaller diameter, and inspect and palpitate the skin prior to each injection to ensure a comfortable injection experience.

Added Dr Niti Desai, Consultant Nutritionist, Cumballa Hill Hospital “With India stated to be the diabetes capital of the world by 2030 with about 80 million people with diabetes and an equal number with pre-diabetics, the burden on health services is going to be huge. Therefore we need certified diabetes educators to get better patient outcomes, reduce health care costs and reduce the burden on doctors.”