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FIT 2.0 Recommendations released to promote correct insulin injection technique in people living with diabetes

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Experts talk of complications of incorrect injection practices that often go unnoticed

Mumbai (January 19, 2015): FIT Insulin Injection Day was observed in Mumbai, with the release of new recommendations for insulin injection usage and a call to combat Psychological Insulin Resistance (PIR) or resistance to initiating insulin therapy and to commemorate the 93rd  anniversary of first successful insulin administration on 11th January 1921, at Toronto General Hospital, Canada.

On this occasion, doctors from various hospitals including Jaslok Hospital, T.N.M.C. & B.Y.L. Nair Charitable Hospital, Cumballa Hill Hospital and Advisory Board members of Forum for Injection Technique (FIT) provided tips on overcoming needle phobia for insulin injection dependent patients.

As per the new recommendations, special emphasis is to be given to counter complications arising out of incorrect usage of injections and usage in special groups like pregnant women and people with weak immunity. In pregnant women, injections should be given in the abdomen using a raised skin-fold. In the first trimester women should be reassured that no change in insulin site or technique is needed. In the second trimester lateral parts of the abdomen can be used to inject insulin, staying away from the skin overlying the foetus. In the third trimester, insulin can be injected over the abdomen while ensuring the skin fold is properly raised. Apprehensive patients may use the thigh or upper arm to inject themselves.

Highlighting on the need to adopt correct injection technique, Dr. (Prof.) H.B.CHANDALIA, President ADE and  Director, Endocrinology, Diabetes & Metabolism, Jaslok Hospital & Research Centre said, “With only about 3 million injecting insulin out of 67 million who live with diabetes, India has low rates of insulinisation.  This is a road block in the optimal management of diabetes.Patients fear initiating insulin because of fear of needles and a sense of life-long dependence on Insulin. Also, many clinicians hesitate to put their patients on insulin therapy as they apprehend losing their patient‘s confidence.

However, awareness on correct insulin administration technique plays a critical role in therapy adoption, adherence and management of diabetes. With the release of FIT 2.0 recommendations on Insulin Injection days, the FIT advisory Board believes that these would enhance awareness about the importance of appropriate insulin administration technique amongst healthcare professionals and patients; hence, optimize the management of diabetes therapy in India.”

The FIT recommendations also suggest that correct injection technique can help protect against lipohypertrophy (LH), unexplained hypoglycemia (low blood sugar) and blood glucose variation. Shorter needles can provide safety from injecting into muscle, as an insulin injection in the muscle may lead to hypoglycemia. Several factors including regular inspection of injection sites, preventing reuse of needle, correct site rotation, influence the success of insulin injection therapy.

Ms. Salomee Benjamin, Chief medical nutritionist and chief dietitian, T.N.M.C. & B.Y.L. Nair Charitable Hospital, Mumbai said, "Association of Diabetes Educators (ADE) is an organisation of healthcare professionals working in the field of diabetes with a vision to build a strong professional body of diabetes educators par excellence in India and to provide a platform through which, benefit to individuals with diabetes is conveyed.

The electronic Diabetes Educators Course (eDEC) is available to graduates in Nutrition, Nursing, Pharma, Occupational and Physiotherapy (eg- BSc Nutrition, BSc Nursing, B Pharm, Bachelors of OT, Bachelors in PT). Additionally, these students should be working for a 3 months period at one of the centers recognized by Help Defeat Diabetes Trust (HDDT) under a recognized mentor. It is a 6 month course, punctuated by continuous self-assessment test and 1 final test taken on-line under the supervision of their mentor. Upon successfully passing the test, a certificate of training by Dr. Chandalia's Diabetes Endocrine Nutrition Management and Research Centre (DENMARC) and HDDT is issued. ADE plans to collaborate with public, private and government organisations towards policy making and advocacy to improve diabetes care in India."

The success of insulin injection therapy and the adherence to it depends on several factors such as a smooth insulin initiation process with counselling that alleviates the fear of needles, the insulin regime, length of needle and the method of administration, For example, it is always preferable to use a new needle for each injection, choose shorter needles with a smaller diameter, and inspect and palpitate the skin prior to each injection to ensure a comfortable injection experience.

Added Ms. Niti Desai, MSc SRD. (UK), Consultant Nutritionist, Cumballa Hill  Hospital “With India stated to be the diabetes capital of the world by 2030 with about 80 million people with diabetes and an equal number with  pre- diabetics - the burden on health services is going to be huge. Also diabetes being a life -long condition and needing continuous patient education - there needs to be concomitant increase in the number of health care professionals to deal with this epidemic like situation. Therefore we need certified diabetes educators to get better patient outcomes, reduce health care costs and reduce the burden on doctors.”