Injection technique and the rights and wrongs of injecting insulin can be something many of us don’t hear much about in clinic, so over the coming week or so i am going to give you as much information as i have about this.
The information and knowledge is coming directly from BD Diabetes Care so it is 100% correct and reliable If there are any of our readers who would like to talk further about your lack of injection technique knowledge just email us on firstname.lastname@example.org and i will do my best to put you in touch with the correct person to talk to.
For the moment here is a brief summary of how our interactive workshop went and what it was about.
About our Interactive workshop @ BD
We ( Liz, John, Mysef – Davina, Mary and Anne ) were required to sit as a panel of experienced Diabetic Patients form 2pm-4.30pm at BD Diabetes Care in Dublin. The aim being to better understand what it is like to live with diabetes and use insulin. The audience, of approximately 30 attendees, will be from the Diabetes Care UK, Ireland Sales & Global R&D Teams.
The format was blocks of questions lasting 30 minutes, with scientific evidence presented as the session progresses lasting 10minutes.
And there you have it, all we had to do was tell the truth, the whole truth and nothing but the truth, and they had the right bunch to do just that.
Here is a small sample of the questions we were are asked and my answers to them.
- In clinic what is expected and what is accepted?
- In Hindsight what do i wish is knew more about and what would you tell yourself to do better?
- Needle Reuse is greater in Ireland than UK and in the UK greater than USA, why do you think that is? Has your HCP every mentioned it and why do you think this is?
- What response do you get when you say to a HCP….”I read on the internet that I should do this….”
Each of these and other questions were answered openly and honestly, but i am inviting you to do the same in the comments below.
In Clinic what is expected and what is accepted.
I suspect this is different from clinic to clinic and from individual to individual, but that in itself is wrong seeing as we leave clinic and go straight to our facebook support groups and share whats just happened. At that moment we realise everyone has a different experience, so im just going to talk about my own here.
What is expected
A fairly decent HBA1C is a good place to start even though this is not really a truthful, focused and clear image of whats happened for the last 3 months.
Good diabetes management can be sabotaged by many things and throw the treasured HBA1C out of whack. Is it just me or is it during those last 3 months before clinic when you get an infection?, you tell the GP NO im not doing steroids it sends me sky high but he promises that nasel spray he prescribed wont do that….. He was lying !
Stress, infusion sets coming adrift at the most inconvenient time, and a whole host of things can make my blood glucose high, ans some of those highs can be difficult to manage.
Its expected that my weight , and my blood glucose are within range, and my retina screen and flu shot are both in order. Its expected that iv taken my diabetes management seriously and that my results reflect that,
What is accepted ?
Any reasonable excuses / reasons for having a higher HBA1C thats not what it should be, any reasonable discussion looking for advice, and if youv got a good endo / diabetes specialist its also accepted that you might get into discussion about new technology or doing things a little differently.
In Hindsight what do i wish is knew more about and what woulod i tell myself to do better?
The answer to this was easy. I wish i knew more about the complications but there seems to be a “need to know attitude” where you only get told if they think you need to know but you don’t if they don’t think its necessary.
Unfortunately if im in a position where they think i need to know and scaring me might just get me to adhere to treatment and management better, then im guessing some damage has already been done.
Just for the record ! fear will always make me think twice before putting my hand on something hot, fear would make me stand back off the edge of a cliff, fear would make me adhere to treatment and manage my diabetes effectively.
FEAR IS NO BAD THING ………. and thats what i remind myself of when i need to do better. There is a very real fear of the complications (eyes, heart, limb amputation, kidneys problems, etc) that can happen if i dont manage my diabetes proactively. My pancreas might have died but when the rest of me does i want to go with all my bits intact.
Needle Re-Use. – o yes we do !!!
We all know that needle reuse is not acceptable or even hygienic, sure thats why we are given our pen needle tips in boxes with more needles that we would ever use in a month.
Reuse of needles will lead to greater scar tissue as the needle becomes blunt and loses its lubrication after the first use, in turn leading to lipohypertrophy,
Lipohypertrophy is when fatty lumps appear under the surface of the skin and is a fairly common side effect of insulin injections. This will usually occur if multiple injections are administered to roughly the same part of the skin over a period of time.
The question was why did we think needle reuse happened ?
We had seen the questions before we got there so we could have time to think and prepare, but i didn’t need to think to hard to answer this one.
I asked them all to imaging being in the supermarket doing the food shop, or even better imagine for a few moments being on a crowded bus with shopping bags on your lap while you are glued to the passenger next to you. The bus is on a bumpy road and youv no lap space to use but you know you don’t feel right and probably need insulin.
I then proceded to give them a visual rather than just explain.
So out came the finger pricker and the test strip, ok iv now established that my blood glucose is out of range and i need insulin.
Then i took out the pen, took the cap off, got the pen needle, ripped off the paper seal, screwed it to the pen, lifted off the outer cover, then the inner cover, dialled up the units needed and injected all while holding all the various parts in my other hand.
Then i had to find the various parts id removed and find a safe place to put them, all on a crowded bus with no lap space.
At that stage i would have had in my hand,
A used test strip
A paper seal
An outer cover
An inner cover
A needle tip
A pen cap
All these in one hand while i put away the insulin pen into its wallet and put it back in the handbag that i wasn’t able to keep hold of while i secured all the little pieces involved in using my insulin pen with a new needle tip.
The far easier and convenient thing to do was to pop the new needle tip on the pen before i left the house and leave it on until i got home, which is exactly what i used to do.
This became so handy that i did it every morning whether i was going out or not.
NOT recommended under any circumstances but i did it, before my pumping days.
My suggestion was that they should manufacture a needle type cartridge for the top of insulin pens, much like the multiclix lancet device.
There will always be a difference between what they think they know to be best practice, and what we actually do. Why ? because we live with this day and night for the rest of our lives.
The problem is not that we do it, its that there is no other option until the manufacturers come up with another / better solution.
I read on the internet …………..
If the moment you uttered these words in clinic was recorded and played back in slow motion, you would see the impact these words had, by “The look” of horror that can reduce us to nothing more than that of a bold child who has done something dreadfully serious that warrents and good telling off.
These words to a diabetes nurse specialist can very often open a door to that dark place of the unknown in their opinion, because if they think you need to know they will tell you but Dr Google is a NO NO……….
Thankfully most of us Nod at all the right times in clinic, answer yes and no in the appropriate palces, and then research the hell out of every single aspect of diabetes until we can find a place to live kinda comfortably with what ever knowledge we have gained.
We really did have a great day, it was packed full of information, They all listened intently to what each of us had to say, we had a delicious lunch, and before we left for home, we were given a tour of the plant where we saw how our needle tips and syringe injections were made, assembled, packaged and boxed for transport to our pharmacies so we can continue to inject our insulin safely and hygienically.
NO ! we did not get paid for our time at BD. We advocates, do this to gain the knowledge we need to be able to write about it, and then we can help you learn too.
For those who think diabetes is caused by an unhealthy lifestyle let me clarify a couple of things.
I have type 1 diabetes. It’s an autoimmune disease. Nothing I did, or didn’t do caused it and nothing I do will cure it. There’s is currently no cure for Type 1 diabetes.
Type 1 Diabetes happens because our own antibodies attack and destroy an organ in the body. it’s an autoimmune response where antibodies that normally fight disease mistake a part of our body
(the pancreas in this case) as foreign and attack to destroy it.
When those antibodies attack the insulin-producing islets in the pancreas we stop producing insulin so we need to inject or pump it.
Without insulin a person with type 1 diabetes would die. At present it is not known what causes this to happen, and there is no cure.
A person with Type 1 diabetes MUST inject or pump insulin to stay alive.
There are many factors that contribute to a diagnosis of Type 2 diabetes so pre judgment of a lifestyle choice is unfair at very least.
A person with Type 2 diabetes, while still producing their own insulin for various reasons their body cannot use it correctly or efficiently.
These people are generally treated with oral medications and sometimes with insulin injections.