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Injection Sites

Assess Injection sites

• Injections of insulin are always given in the same place
• The needle is reused. View Image courtesy of Ypsomed

Always conduct physical examination of injection sites

• Ask the patient to remove clothing and stand in a relaxed position (this is the best way to search for lipos)
• If the patient declines to have sites examined record in patient notes

Next:

1. Observe sites
2. Palpate sites – this often best done by smoothly and firmly stroking your finger across the injection site. If lipos are present you feel a subtle difference in the subcutaneous tissue – soft outside the injection site firmer and harder at the injection site. If in doubt refer to the diabetes service specialist nurses. 
3. Give risk of lipodystrophy guidance to all patients who inject insulin
4. Give guidance to patients with lypos
5. Consequences of using lipo sites to inject insulin

Injection of insulin into a lipo site can result in the insulin not being absorbed or at least being absorbed erratically. This results in very unpredictable blood glucose levels with consequent hypos and hypers. Note: if a patient who uses insulin presents with a recent history of erratic blood glucose control i.e. unexplained hypos and hypers it is highly likely they have lipodystrophy.

Lipos can be prevented by:

• Rotating injection sites. Each injection site has a different absorption pattern and in order to reliably predict the effect of a dose of insulin, you should keep a consistent site for each time of day. View image courtsey of Ypsomed
• Rotating within injection sites View image courtsey of Ypsomed
• Using a new needle for every injection View image courtsey of Ypsomed

If a lipo is found:

• Advise patient not to inject into the lypo site until normal sko=in texture is restored
• Show your patient alternative sites
• Enable patient to rotate and change needles thus reducing risk of lipos developing in the future

• Give people clear written guidelines instructing them where they can and cannot inject

www.bddiabetes.co.uk

• Follow up and review lypos at 3 monthly intervals
• If problems persist refer to diabetes centre

Note: BD Medical produce a superb patient booklet called: Fax. 01865 781551

This work has been completed with the support of Lilly UK through an educational grant, which includes permission to use the basic IT structure and design of the website and the provision of Project Management training to the project team.