Clinical Health Updates

Angled insulin insertion with 6-mm needle best for children with Type 1 Diabetes Mellitus

Clinical Question:
What needle length and injection technique most reliably delivers insulin into subcutaneous fat in children with diabetes?

Bottom Line:
A pinched technique with angled insertion using 6-mm needles most reliably results in the appropriately placed subcutaneous injection of insulin in children with diabetes. This same needle-size used in the abdominal site also resulted in the least amount of injection pain.

Hofman PL, Lawton SA, Peart JM, et al. An angled insertion technique using 6-mm needles markedly reduces the risk of intramuscular injections in children and adolescents. Diabetic Medicine 2007;74(12):1400-1405.

Study Design:
Non-randomized controlled trial

The authors aims of this study were
(i) to establish which children with Type 1 diabetes are at risk of intramuscular or intradermal insulin injections
(ii) to determine a needle length and technique that reliably administers insulin into subcutaneous fat.
Seventy-two healthy diabetic children (age 6.3-14.3 years, body mass index standard deviation score 1.0 +/- 1.4) were recruited for study 1 and 37 of this cohort participated in study 2. In study 1, 200 microl air was injected into the abdomen and anterior thigh by a pinched skin-fold technique using either a perpendicular insertion of NovoFine(R) 31G 6-mm or an angled insertion of NovoFine(R) 30G 8-mm needles. In study 2, subjects received injections into abdomen and anterior thigh via angled 6-mm needles with either an unpinched or pinched technique. The site of air injection was visualized by ultrasound scan and measurements taken of subcutaneous fat thickness. In study 1, intramuscular injections were detected in 32% of subjects, and in a further 22% air was visualized at the muscle fascia. In study 2, intramuscular injections occurred in 3% of subjects and a further 11% had muscle fascia air detected. No intramuscular injections occurred in subjects injecting with a 6-mm needle and an angled pinched skin-fold technique. Pinching abdomen and thigh skin folds increased the subcutaneous fat thickness by 192 +/- 16% and 22 +/- 6%, respectively. In very lean subjects, pinching thighs actually reduced subcutaneous fat thickness.