The Golden Rules of Injection Technique

Jul 11, 2017

Findings from a recent worldwide survey - the largest-ever on injection technique - reveal the majority of people with diabetes who rely on injectable medications are not injecting correctly.1

The survey was conducted with more than 13,289 people participating from 42 countries, including Australia.1 The results were reviewed and analysed by over 180 diabetes experts from 54 countries, resulting in the ‘Golden Rules of Injection Technique’ being published. These Golden Rules were developed to help people better manage their diabetes, in consultation with their healthcare professional.1

Professor Glen Maberly, Endocrinologist and Program Lead of Western Sydney Diabetes, and member of the expert group that analysed the worldwide survey results, said the survey responses highlight the importance for people with diabetes to recognise that injection technique is just as crucial in diabetes care as their diabetes medication, nutrition and physical activity.

“Even people who have been injecting their diabetes medication for many years can develop poor or inconsistent injection technique, which can impact their blood glucose control and affect their health,” said Professor Maberly.

“It is vital that people who inject their diabetes medication have regular discussions with their healthcare professionals about injection technique to ensure they understand the importance of needle length, injection angle, using a skin fold, and correct injection site rotation to better control their diabetes.”

Golden Rule #1: Always inject into the healthy fatty layer under your skin1

For diabetes medication to work properly, it needs to be injected into the fatty layer under the skin, avoiding the muscle.2 It is also important to use a new site for every injection. People should not inject into the same injection site repeatedly.1 If diabetes medication is injected into a muscle, a scar, or any area where the skin feels thick or lumpy, the medication may not work the way it's supposed to and may lead to changes in blood glucose levels and increased medication requirements.1,3

Golden Rule #2: 4mm pen needles, inserted at 90 degrees are recommended for all adults and children1*

A 4mm pen needle is considered suitable for adults and children - regardless of age, sex, ethnicity or body weight.1 This is because a 4mm pen needle is short enough to pass through the skin with little risk of injecting into a muscle.1 Additionally, because of its short length, the 4mm pen needle can be injected straight into the skin at 90 degrees without a skin fold.1^

Golden Rule #3: Inject diabetes medication into areas on the abdomen, thighs, and buttocks1

It's important to rotate injection sites correctly to help keep all sites and skin tissue healthy. Injection sites can be rotated from one body area to another however it's important to note the abdomen, thighs, and buttocks can absorb diabetes medication differently.1 It's recommended people who inject their diabetes medication work closely with their healthcare professional to develop a suitable injection site rotation plan.1

Golden Rule #4 Check injection sites for lumps and bumps1

Thickened skin or rubbery lumps and bumps can build up in the fatty layer under the skin at injection sites.3 People should not inject into these lumps and bumps - which are sometimes referred to as 'lipos' - and regularly consult their healthcare professional to ensure lipos do not develop at their injection sites.1 If these lumps and bumps are injected into, the medication may not adequately control blood glucose levels.3,4 To avoid developing these lumps and bumps, medication should be injected into a new site using a new needle at every injection.1

Golden Rules #5 Rotate injection sites properly1

It's important to rotate injection sites to retain healthy skin, reduce risk of developing lumps and bumps (lipos) and ensure diabetes medication works as it's supposed to. It's recommended that people inject at least 1cm (or approximately the width of an adult finger) from their previous injection site. A single injection site should not be used more than once every 4 weeks.1 When injection sites are rotated correctly, skin tissue can heal between injections, and may help reduce skin complications.1, 3

In support of these 5 Golden Rules of Injection Technique, BD works closely with healthcare professionals and people who inject their diabetes medication to encourage healthy injection habits.

^ Children 6 years and under and very thin adults should perform a skin fold and inject at 90 degrees. Note that a 2-finger skin fold usually prevents injection into the muscle in children, but is much less effective in the thigh than in the abdomen.1

  1. Frid AH, Kreugel G, Grassi G et al. Mayo Clin Proc. September 2016:91(9):1231-1255.
  2. Gibney MA, Arce CH, Byron KJ, et al. Curr Med Res Opin. 2010;26(6):1519-1530.
  3. Blanco M, Hernandez M, Strauss K, et al. Diabetes Metab. 2013; 39(5): 445-53.
  4. Johansson UB, Armsberg S, Hannerz L, et al. Diabetes Care. 2005; 28:8:2025–2027.
  5. Aronson R, Gibney MA, Oza K, et al. Clin Ther. 2013;35(7):923–933.