New Short Needle Removes Fear of Diabetes Injections
10 May 2010
Why would a 200 pound, tough, football player suddenly turn pale and develop circulatory collapse from such a trivial event? I’ll never forget this scene at the Montreal General Hospital many years ago. A football playing friend, whom I had known for years, was visiting Montreal and required a needle injection due to a serious infection. A few seconds after this event his huge, hulking frame suddenly collapsed and he was lying semi-conscious on the floor.
The diagnosis was Belonephobia (Needle Phobia) and although it’s a relatively rare condition many people have needle anxiety and find injections intimidating. This can have a profound effect on the treatment of those with diabetes.
Today, 247 million people worldwide have diabetes. In North America, a new case is diagnosed every 45 seconds! Complications of diabetes such as blindness, renal failure, heart attack and leg amputation will cause a huge amount of personal suffering and the cost of treatment could cripple our health care system.
Patients with Type 1diabetes, the result of inheriting bad genes, need insulin injections to survive. Obesity is responsible for 90 percent of those with Type 2 diabetes. Initially, they can be treated with oral medication, but eventually 39 percent of these patients over 18 years of age require insulin. This is when the challenge begins for those with needle anxiety.
Needle anxiety often starts early in life when as children, they were injected with what looked more like horse needles. Small wonder that they shy away from needle injections.
The goal in treating diabetes is to maintain a normal blood sugar level day after day. This is easier said than done due to human error. But it’s now possible for doctors to know whether or not patients are adhering to their treatment. A blood test called, A1C, indicates how well glucose (sugar) is adherent to red blood cells over a long period of time. Doctors know that if the test is abnormal, patients are getting careless and skipping injections.
Now there’s less reason for patients to be careless. Today, needles used for insulin injection, given with insulin pens may be as short as 4 millimeters (4 mm), and as fine as a 32 gauge needle (G- a medical term for the diameter of the needle) This is a far cry from the glass syringes and much bulkier needles which were used decades ago.
At a recent International meeting in Athens, Greece, specialists in diabetic care stressed that the technique of injection is critical to the successful use of insulin. Researchers reported that some doctors are not always aware of the hows and whys of proper needle technique. In effect, there’s more to insulin injection than simply jabbing a needle through the skin.
For instance, using MRI and Ultrasound studies, researchers have been able to measure the thickness of skin and fat at several injection sites. They found that skin is rarely thicker than 2.5 millimeters (mm). And that fat thickness is much thinner than previously believed, particularly in the thigh and outer areas of the abdominal wall.
This means that overweight adults and children can use short 4 mm needles, rather than the longer 12 mm ones. A short needle also increases the chance that insulin will be injected into subcutaneous tissue beneath the skin, rather than into muscles.
These studies also enabled researchers to determine what happens to insulin following injection. They discovered that injecting insulin frequently into the same area triggered the formation of what’s called lipos. These repeatedly used injection sites look somewhat like sponge-cake and can slow down and cause erratic absorption of insulin. So it’s important for patients to frequently change injection sites.
Today with Type 2 diabetes reaching epidemic proportions an increasing number of patients will be advised to use insulin injections for improved control of blood sugar. Fortunately, these short, four millimeter needles, so thin you may need glasses to see them, will make this transition easier.
Tiny needles will also help to discourage children and others from skipping injections. And they may even prevent my macho football friend from suddenly dropping to the floor from Belonephobia.
