From the Guidelines
The best delivery for bad injections is to ensure that insulin is injected into subcutaneous tissue, not intramuscularly, and to use proper injection technique, including site selection and needle size, to minimize complications and optimize glucose control. According to the most recent evidence 1, proper insulin injection technique includes injecting into appropriate body areas, such as the abdomen, thigh, buttock, and upper arm, and avoiding intramuscular (IM) insulin delivery.
Key Considerations for Insulin Injection Technique
- Injecting into subcutaneous tissue, rather than intramuscularly, is crucial to avoid unpredictable insulin absorption and variable effects on glucose 1.
- Recommended sites for insulin injection include the abdomen, thigh, buttock, and upper arm, with a preference for truncal sites (abdomen and buttocks) in younger, leaner individuals to reduce the risk of IM insulin delivery 1.
- Using short needles (e.g., 4-mm pen needles) is effective and well tolerated, and can help minimize the risk of IM insulin delivery 1.
- Injection site rotation is necessary to avoid lipohypertrophy, an accumulation of subcutaneous fat that can contribute to erratic insulin absorption and increased glycemic variability 1.
Preventing Complications and Optimizing Glucose Control
- Proper training, patient positioning, and anatomical landmark identification are essential to reduce injection complications and optimize glucose control 1.
- Educating patients and/or caregivers about proper injection site rotation and how to recognize and avoid areas of lipohypertrophy is critical to preventing complications and optimizing glucose control 1.
- Regular examination of insulin injection sites for the presence of lipohypertrophy, as well as assessment of injection device use and injection technique, are key components of a comprehensive diabetes medical evaluation and treatment plan 1.
From the FDA Drug Label
Inject Adrenalin® intramuscularly or subcutaneously into the anterolateral aspect of the thigh, through clothing if necessary. For intramuscular administration, use a needle long enough (at least 1/2 inch to 5/8 inch) to ensure the injection is administered into the muscle. Do not administer repeated injections at the same site, as the resulting vasoconstriction may cause tissue necrosis.
The best delivery method for epinephrine injections in cases of bad injections is intramuscularly into the anterolateral aspect of the thigh, using a needle that is at least 1/2 inch to 5/8 inch long to ensure the injection is administered into the muscle 2. It is also important to not administer repeated injections at the same site to avoid tissue necrosis.
From the Research
Factors Influencing Pain Sensation at the Injection Site
- Needle features, such as short and thin needles with sharp tips, can minimize pain 3
- Injection site, with the abdomen being a less painful site than the thigh 3
- Volume injected, with larger volumes associated with more pain 3
- Injection speed, with faster injections potentially causing more pain 3
- Osmolality, viscosity, and pH of formulation, with isotonic solutions and a pH close to physiological levels recommended to minimize pain 3
- Excipients, such as buffers and preservatives, can affect pain sensation, with certain concentrations and types being more painful than others 3
Comparison of Injection Routes
- Subcutaneous (SC) injection may be better than intravenous (IV) injection for certain medications, such as trastuzumab and rituximab 4
- IV injection may be better than SC injection for certain medications, such as ketamine and vitamin K1 4
- Intramuscular (IM) injection may be better than IV injection for certain medications, such as epinephrine and hepatitis B immunoglobulin 4
- SC injection may be better than IM injection for certain medications, such as interferon-beta-1a and methotrexate 4
Adverse Reactions and Injection Site Reactions
- Adverse reactions can occur with any injection route, but may be more severe or prolonged with certain routes 5, 4
- Injection site reactions, such as swelling, erythema, and pain, can occur with subcutaneous injections, but can often be prevented or minimized with proper injection techniques and patient education 6, 3
- Reimmunization after an adverse event can be safe and effective, but should be done under the guidance of a healthcare professional 7