From Lancaster New Hampshire, USA:
I would like to know the least painful technique to injecting insulin on a seven year old thin boy just recently diagnosed with type 1 diabetes. He receives his insulin times per times a day after every meal. We are currently using ultra-thin II 30 unit syringes and we are trying to rotate the sites. A description of a proven technique would gladly be appreciated.
I would like to be more helpful, but I am not certain I understand the real issue: Is it that you can't find a "pudgy" enough spot? Or is it really one of pain? Are all the shots painful? Or just the ones in certain locations? Is the pain associated with the actual insertion of the needle or rather the administration of insulin? Or is the real issue not the injection, but the potential fear associated with the shot, and your son must be held down? You stated that you use an "ultra thin" needle. Is this the "short" needle?
Here are suggestions:
- Use a short needle. B-D now makes an even shorter needle called a mini. Try it. The needles on insulin pens are shorter than regular needles also. They are essentially like the mini needles. Insulin pens are great, but you cannot mix insulins; one must take a shot of short-acting insulin and a separate shot of the longer-lasting insulin.
- If you use alcohol to cleanse the skin, be certain that it is completely dry prior to the injection. After an injection, you have just "drilled a hole" and alcohol into this hole can sting. Try soap and water to cleanse the skin, again assuring the area is dry prior to injection.
- You might try an injection device such as an Inject-Ease®. This is a simple device into which you place your insulin syringe. It is a spring-loaded device that inserts the needle with the same degree of force each time. It also "hides" the needle to as to decrease the apprehension children (and some parents have) of being "stabbed." This type of device negates the "stabbing too far" factor. Your diabetes team probably has one of these inexpensive devices and can show you how to use it.
- The skin may be numbed a bit -- even for some emotional benefit. Try rubbing some ice on the injection site for a few minutes prior to cleansing. One trick is to lay a sugar-free popsicle on the site to numb it up. After the injection, the reward for the well behaved child is to eat the popsicle. You can try more medical numbing agents such as EMLA (not currently readily available) or ELA-Max, but the time required and the mess and the additional cost may not be worth it. [Ed: See Eichenfield LF, Funk A, Fallon-Friedlander S, Cunningham BB. A clinical study to evaluate the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics cream for pain reduction of venipuncture in children. Pediatrics. 2002 Jun;109(6):1093-9.]
- Although there are some differences in rates of absorption, you might try the "fatter" aspects of the hips and mid-thighs. There are fewer nerves along the abdominal skin so by-and-large, I think most people with diabetes generally prefer their abdomen as injection sites. Yes, your son is thin, but I have rarely met the child in whom I could not "pinch an inch." I tell parents to make an imaginary one-half to one inch box surrounding the belly button and avoid everything in that box.
- With the "pinching" the area of skin, generally it is better to insert the needle at about a 45 degree angle. This is done to prevent the insulin from percolating back out: the skin and tissues collapse upon themselves, collapsing the well you just drilled. With the Inject -Ease, the device actually "twists" the skin a little bit and you can come in at 90 degrees (perpendicular) to the skin. Alternatively, instead of pinching a bit of skin, you can firmly retract the skin and subcutaneous tissue, and also insert the needle at 90 degrees. Then when you release the skin, the hole you drilled is again covered back up trying to limit the leakage of insulin.
- Insulin injections with the ultrafine needles tend to be relatively painless. So I wonder how much of your son's issues relate to fear given his relatively new diagnosis. That said, injections of cold insulin tend to hurt more than room temperature insulin.
Finally, engage your son in "helping" with the injection: Let him choose the spot; may be he can press the plunger down on the syringe. Personally, I think it more of a problem to argue, rationalize, convince and contrive and discuss with children about the shot. Just do it, recognizing that no one is happy about it, but it's fast, done. In addition, reward yourselves with some different, more positive bonding time: playing a game, reading, etc.
Original posting 22 Jul 2003
Posted to Blood Tests and Insulin Injections
Last Updated: Tuesday April 06, 2010 15:09:45
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