Diabetes
focus
Comment
“Teaching injection technique
will improve quality of life”
U
p to 24,000 diabetes-related
deaths could be avoided
each year in England if
patients and doctors better
managed the condition, a
recent report by the NHS Information
Centre (2012) has found. The report high-
lights poor management, such as not
taking medication appropriately.
Around 2.75 million people in the UK
have diabetes, and this is forecast to climb
to four million by 2025 (Diabetes UK,
2008). Nearly 800,000 people with diabetes
are estimated to use injectable therapies
(BBC News, 2006). For these to work opti-
mally, correct injection technique is essen-
tial. It is therefore vital to support health
professionals in helping people with dia-
betes best manage injectable therapies.
Incorrect technique, including using
the wrong needle length, can lead to thera-
pies being absorbed in an unpredictable
manner. This may cause immediate prob-
lems such as hypoglycaemia or hypergly-
caemia, and ketoacidosis in type 1 diabetes.
Other consequences of injectable thera-
pies, particularly insulin, not being admin-
istered correctly are lipohypertrophy (accu-
mulation of fat under the skin), lipoatrophy
(wasting of subcutaneous tissue) and
bruising and bleeding at the injection site.
Longer-term complications relating to
poor diabetes management can include
heart or kidney failure, stroke and blind-
ness. Diabetes treatment and complica-
tions cost the NHS approximately £1m per
hour, or £9bn a year – about one tenth of
the NHS budget (Diabetes UK, 2008).
16 Nursing Times 06.03.12 / Vol 108 No 10 / www.nursingtimes.net
Unfortunately, injection technique has
not been emphasised in managing injec-
tion therapies. But it is the role of all health
professionals to educate and treat people
with diabetes, give training and advice on
best practice, and regularly monitor their
injection technique and injection sites.
Many people with diabetes do not
remember receiving education on injec-
tion technique. While this does not mean
Unfortunately, injection
technique has not been
emphasised in managing
injection therapies
they did not receive such education, it
demonstrates that the way best practice is
taught and refreshed needs to be improved.
In 2009, to raise awareness of this issue,
a group of like-minded, experienced dia-
betes specialist nurses formed the Forum
for Injection Technique (FIT). The forum
is dedicated to establishing and promoting
best practice in injection technique, and
raising awareness of emerging and
existing research relating to injection
technique and the impact this may have
on health outcomes. FIT’s vision is to
help those using injectable therapies to
achieve the best health outcomes by
ensuring the dose is delivered to the right
injection site, using the right technique
every time.
In October 2010, the first UK Injection
Technique Recommendations for health
professionals and people with diabetes
who use injectable therapies was pub-
lished by FIT (Training, Education and
Research for Nurses in Diabetes UK, 2010).
The recommendations cover topics such
as needle length, bruising, pregnancy and
insulin dosage.
Helping to develop educational tools
for health professionals will support
people with diabetes to manage their
injectable therapies in the best way. FIT
believes this can be achieved by imple-
menting the UK injection technique rec-
ommendations, with supporting educa-
tional programmes for people with
diabetes and health professionals.
FIT strives to examine practice within
the field of injection technique, promote
research in this field, develop initiatives to
address areas of concern and encourage
innovative approaches. NT
Debbie Hicks is nurse consultant, diabetes,
Enfield Community Services, Barnet, Enfield
and Haringey Mental Health Trust; chair,
Forum for Injection Technique; and co-chair,
TREND-UK
References
BBC News (2006) Diabetes Inhaler Rejected for
NHS. 19 April. London: BBC News.
Diabetes UK (2008) Beware the Silent Assassin.
London: Diabetes UK. tinyurl.com/DUK-assassin
NHS Information Centre (2012) Up to 24,000
People with Diabetes Suffer an Avoidable Death in
England Each Year. tinyurl.com/diabetes-
unavoidable-death
Training, Education and Research for Nurses in
Diabetes UK (2010) Diabetes Care in the UK - the
First UK Injection Technique Recommendations.
London: Forum for Injection Technique, TREND-
UK. www.trend-uk.org