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An angled insertion technique using 6-mm needles markedly reduces the risk of intramuscular injections in children and adolescents

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Abstract Aims 

The aims of this study were (i) to establish which children with Type 1 diabetes are at risk of intramuscular or intradermal insulin injections and (ii) to determine a needle length and technique that reliably administers insulin into subcutaneous fat. Methods 

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 µl air was injected into the abdomen and anterior thigh by a pinched skin-fold technique using either a perpendicular insertion of NovoFine® 31G 6-mm or an angled insertion of NovoFine® 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. Results 

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. Conclusions 

While intramuscular injections were observed frequently using standard injection protocols, an angled 6-mm needle technique reliably injects into the subcutaneous fat.

Diabet. Med. 24, 1400–1405 (2007)
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Keywords: intramuscular injection; needle length; subcutaneous fat thickness

Document Type: Research Article

Affiliations: 1: International Medical Affairs, Novo Nordisk, Copenhagen, Denmark 2: Auckland Radiology Group, Auckland 3: Epidemiology and Biostatistics Section, School of Population Health, University of Auckland, New Zealand

Publication date: 01 December 2007

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