How To Reduce Injection Anxiety
Most children and adolescents find the pain when injecting insulin quite small. However, injection pain and needle phobia are major problems for a small group, even after many years of diabetes. Scientific studies have shown that the use of an indwelling catheter (Insuflon®) for introducing insulin injections at the onset of diabetes results in an evident relief of pre-injection anxiety, injection problems, and the pain of repeated injections. The average indwelling time is 3-5 days. The catheter is most often inserted in the abdomen but the buttocks and other areas can also be used. Topical anesthetic cream is recommended before insertion. Parents will quickly learn to replace the device at home. Fixation problems and local redness at the insertion site are the most frequent side effects. However, the frequency is low and they can be dealt with effectively. Needles 10 mm or shorter should be used for injecting to avoid penetration of the tubing of the catheter. Using indwelling catheters for up to 4-5 days does not affect the absorption of insulin. The long-term (measured by HbA1c) and short-term glucose control (measured by blood glucose profiles and insulin levels) is not altered.
The dead space of the catheter is about 0.5 unit of U100 so it may be necessary to give 0.5 units extra with the first dose after insertion if the child uses small doses.
NPH insulin (Humulin N, Novolin N and similar) is well mixable with both regular insulin and insulin analogs and can be given in the Insuflon catheter. The uptake of NPH insulin may be quicker if it is given in the abdomen and this needs to be discussed with your doctor. When mixing insulins in Insuflon, 0.2-0.3 units of the second type of insulin will be trapped in the dead space. These small amounts of insulin are usually not of any practical significance since the youngest children with very small doses often use diluted insulin.
Using this type of injection aid may decrease the risk of future injection problems, which are not uncommon among persons injecting insulin, and facilitate the use of intensive insulin therapy which may contribute to a decreased risk of long-term complications. Insuflon can safely be used from the onset of diabetes to lessen injection pain in children and adolescents and is also helpful for those who have tried regular injections and find them painful. The catheter will be very useful if your child is reluctant to start up with multiple injections. It also facilitates a more flexible eating pattern since it doesn't "cost" any extra pain to take an extra dose for example when having an ice cream at the beach. For a infant or toddler who cannot understand the necessity of painful injections, Insuflon is a way to take away most of the pain involved.
Use of an indwelling catheter is highly recommended at the onset of diabetes for children 10-12 years or younger, and for those children that have tried regular injections and find them painful.
Ragnar Hanas, MD
Donika, 3 years, sits in her mother's lap when she gets her injections. If she is hungrier than anticipated, she will just get an extra injection after the meal without any extra pain. (In this photo, the Insuflon is being used.)
Last Updated: Sunday April 01, 2007 11:20:49
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