Why insulin often fails to work: Physician's lack of knowledge, time constraints, and scarcity of guidelines adapted to local needs could be the possible reason

By Syed Akbar
Hyderabad: In the first-ever guidelines on insulin
administration by diabetics in India, experts suggest that the site of
daily injection should be changed regularly to avoid thickening of the
skin and consequent poor absorption of the medicine. Shorter needle
should be preferred and doctors should examine the site of insulin
injection whenever patients revisit them for diabetic management.

The first Indian recommendations for best practice in insulin
injection technique released by the Forum for Injection Techniques,
India chapter, point out that a little extra care during insulin
administration will help in prevention of insulin-related
complications like hypo- or hyper-glycaemia. It will also help in
reducing the risk of contamination,
increase the consistent delivery of insulin into the subcutaneous
space, and achieve
optimal blood sugar control

The insulin guidelines gain significance as India has about 6.5 crore
diabetics and 12 lakh patients depend on insulin injections to lead a
normal life. “If injection technique is incorrect, there is a high
risk of poor glycemic control. If needles are reused or used
improperly, it can result in pain with bleeding and bruising, chances
of breaking off and lodging under the skin, risk of contamination,
dosage inaccuracy, and lipohypertrophy (lump under the skin),” the
guidelines warn.

Physician's lack of knowledge, time constraints, and scarcity of
guidelines adapted to local needs could be possible reasons
contributing to such factors, the guidelines add.
They suggest that in case a refrigerator is not available, the insulin
vial can placed in a water-filled earthen pitcher. While travelling,
insulin should be kept in a flask with ice, or in a handbag, or in a
proper container if the outside temperature is more than 30 degrees
Celsius.

The recommendations include injecting the right insulin strength with
the right insulin syringe, adults need not require lifting of a skin
fold in case of 4 mm needles, the injection site should be cleaned
using cotton balls dipped in water or with alcohol swabs, washing of
hands with soap and water, and systematically rotating the injection
site for optimised insulin absorption. Injecting insulin through
clothing should be avoided.