According to statistics, nearly 1/3 of diabetic patients in China receive insulin therapy, and insulin injections have become a daily “must” for these patients. However, many patients are not standardized in the injection technique, resulting in a significant reduction in the effect of insulin, thus affecting the control of blood glucose to the standard. In order to standardize insulin injection techniques, the Chinese Medical Association Diabetes Branch officially promulgated the first “Guidelines on Insulin Injection Techniques for Diabetes in China” (hereinafter referred to as “Guidelines”) on August 14 this year, and designated November 7 of each year as “Diabetes Standard Injection Day”. Below, the author will briefly discuss the common clinical problems in insulin injection and how to standardize the operation, taking into account the relevant contents of the Guidelines. Problem 1: Neglecting the selection and rotation of injection sites Some patients play insulin very casually and feel that they always play that one place because they feel comfortable with which part of the body, and even the local skin has hard knots, which is very wrong. Insulin is usually injected subcutaneously, and it is appropriate to choose the area with loose skin. There are not too many parts of our body that are suitable for insulin injection, mainly the abdomen, the front and outside of the arm, the front and outside of the thigh and the outer upper 1/4 of the buttocks. The reason for this is that there is a layer of subcutaneous adipose tissue under these areas that can absorb insulin, and there are no more nerves distributed, so there is relatively less uncomfortable feeling when injecting. Different parts of insulin absorption from fast to slow are: abdomen, upper arms, thighs and buttocks. For short-acting (or fast-acting) insulin or premixed insulin and its analogues used to control postprandial blood glucose, the abdomen, where absorption is faster, is generally chosen for injection to facilitate the rapid onset of insulin because it is required to work as fast as possible; while for basal insulin (mainly medium- and long-acting insulin), the front and outer thighs or buttocks, where absorption is slower, are generally chosen for injection to reduce or avoid hypoglycemia (especially at night). or avoid the occurrence of hypoglycemia (especially at night). Repeatedly injecting insulin at the same site will lead to subcutaneous fat growth and hard nodules at that site, which will delay or destabilize insulin absorption and thus affect blood glucose control. Therefore, it is necessary to rotate the injection sites regularly. The rotation of injection sites includes the rotation between different injection sites and the rotation of areas within the same injection site. The rotation of different injection sites refers to the rotation of injections between abdomen, arm, thigh and hip, and there are two methods: one is to follow the method of once on the left and once on the right; the other is to follow the method of one week on the left and one week on the right. In contrast, rotation of areas within the same injection site requires moving away from the previous injection site by a distance of about 1 finger width (about 2 cm) for the next injection, and repeated use of the same injection site within a month should be avoided as much as possible. In addition, when choosing an abdominal injection, the area within 3-5 cm of the umbilicus should be avoided because the area is rich in blood vessels. Note: Unbroken skin should be selected for insulin injection and repeated use of the same injection site within a month should be avoided as much as possible. Once you find pain, indentation or hard knots at the injection site, you should stop injecting in the area until the symptoms disappear. Otherwise, it will affect the absorption and utilization of insulin. Problem 2: Reuse of disposable needles Many insulin patients, for economic reasons, tend to use a needle for a week or even longer before replacing it, which is not desirable. This practice is undesirable because repeated use of needles for injection pens will cause blunting and barbing of the needle tip, which will not only increase the pain of patients during injection, but also easily produce hard skin nodules that affect insulin absorption and increase the chance of infection and needle breakage. Therefore, the Technical Guide to Insulin Injection for Diabetes in China recommends that diabetic patients should observe the principle of “one needle for one change” during insulin injection. Problem 3: Insufficient attention to details such as needle selection and injection angle Insulin should be injected subcutaneously. If the needle is too shallow and only reaches the skin layer, insulin absorption will be slowed down, which is not conducive to blood glucose control; if the needle is too deep, the drug will probably hit the muscle or even the vein, which will not only increase the pain, but also significantly accelerate the absorption rate of insulin, leading to blood glucose fluctuations and increasing the risk of hypoglycemia. To ensure that insulin is injected into the subcutaneous layer, the angle of entry must be determined by the patient’s body fat and the length of the needle used. When the patient is a child or a thin adult, it is best to choose a short needle for injection. If a longer needle (8mm or more) is used to inject insulin, the skin must be pinched up and injected at an angle of 45 degrees to increase the thickness of the subcutaneous tissue and reduce the risk of injecting insulin into the muscle layer; when the patient is fat or a shorter needle is used to inject insulin, it is not necessary to pinch up the skin and the needle can be injected vertically. Currently, BD has launched an ultra-fine and ultra-short pen needle with a length of only 5 mm, which can be used by any patient without pinching the skin and can be injected directly under the skin. It is especially suitable for children as it is painless. It should be reminded that the injection angle of the needle cannot be changed during the process of injection. Problem 4: unreasonable choice of injection device At present, there are still many diabetic patients who use ordinary syringes to extract and inject insulin, which is not only inconvenient, but also difficult to ensure the accuracy of the injected dose. The Technical Guideline for Injection of Diabetes Drugs in China points out that insulin injection pen has the advantages of accurate dose adjustment, easy to use, easy to carry and easy to grasp by patients, so it is recommended that patients use insulin injection pen for insulin injection as much as possible. Problem 5: Forgetting to mix insulin before injection For insulins with opaque appearance and non-single component, such as various premixed insulins and their analogues, low-refined protein insulin (NPH), etc., regardless of whether they are bottled or pre-filled pen-type preparations, they need to be fully mixed by turning or rolling before injection. In conclusion, the efficacy of insulin is not only related to whether the treatment plan is reasonable, but also the correct insulin injection technique (including the injection apparatus and injection method) is an important factor, which directly affects the accuracy of insulin dose and the performance of insulin action, and to some extent, the success or failure of blood glucose control.