A few posts ago I introduced you to insulin, one of the many drugs that we use to help lower blood sugar. One of the biggest obstacles for new diabetics is the fear of insulin, or rather the fear of needles and daily injections. In some patients we are able to avoid insulin by using other medications like metformin and glyburide or controlling diabetes through proper nutrition and exercise; however, some diabetics need to use insulin to control their blood sugars. Injecting yourself with insulin for the first time can be really scary, but it does not have to be a painful process if you follow proper technique.
Before I discuss how to inject insulin, I want to talk to you about needles. If you are like approximately 10% of Americans, you experience Trypanophobia or “fear of needles.” As children we are given many vaccines, using needles, so it is understandable why we associate needles with discomfort and sometimes pain. To put your mind at ease, let’s talk about the difference between the needles used for vaccinations and insulin needles.
The two main characteristics that determine the size of a syringe (“needles”) are gauge and length. If you have a piercing you are probably familiar with the term “gauge.” The gauge is the measurement of the thickness of the needle. The important thing to remember when choosing the gauge is that the higher the number, the thinner the needle. For example, a 32 gauge needle would be much finer than a 21 gauge needle.
To put things in perspective, let’s think about needles that we are familiar with. I’ve already mentioned piercings – a traditional ear piercing is done with an 18 to 20 gauge needle. How about when you get your flu shot? Your nurse is using a needle that is probably a 23 to 25 gauge needle. For me, the most painful injection has always been a blood draw or when they put an IV in. Depending upon what kind of IV or draw they are doing, the gauge can be anywhere from 16 to 20. In pediatric patients they use a smaller syringe that is 22 gauge. So, drum roll please…what size is an insulin syringe? Believe it or not, the most common insulin syringes range from 29 to 31 gauge! In fact, some lancets that you use to test your blood sugar are 28 gauge, so they are even bigger than some of the biggest insulin syringes! If you can test your blood sugar, you can inject insulin.
The other important characteristic is length of the needle. When we are injecting insulin, we want it to go into your fat cells. This is why we inject into areas like the stomach, back of the arm, thigh, or hip. A quick anatomy lesson – your fat is located as a layer beneath your skin and lies on top of your bones, muscles, and organs. When we give certain vaccines, like flu shots, we use long needles because the vaccine needs to go into the muscle, so we need a longer needle to go through the layer of fat. But insulin is injected into the fat, which is right there under the layers of skin. Why is this important? Because we can use a shorter needle! The size of needle used for a flu shot, for example, is 1 inch to 1 1/2 inches, depending upon the weight of the patient. But for insulin injections, the needle length can range from 1/2 inch to 1 inch, again depending upon the weight of the patient. For people who are afraid of needles, it might be helpful to remember that insulin needles are some of the smallest and thinnest needles that are available.
There is a third characteristic which is capacity (the amount of units of insulin that a syringe can hold) that is important when choosing syringes for injecting from vials of insulin. For example, if you inject 75 units of insulin at a time, you need a syringe that goes up to 100 units so you don’t have to inject yourself multiple times to get your dose. Some syringes have 1/2 unit markings too, which may be helpful if your insulin is dosed by the 1/2 inch. If you are using insulin pens instead of vials, you will be using pen needles instead of syringes, so there is no capacity measurement.
So the bottom line is, put the needle in perspective when thinking about injecting insulin for the first time. Am I going to tell you that it won’t be uncomfortable and scary? No. But if you’re expecting it to feel like the most painful flu shot or blood draw of your life, think again. In my next blog I will give you even more tips for a more painless insulin injection.
Just thought I’d include this cartoon because I thought it was very cute. It’s all a matter of perspective.