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"Teaching injection technique will improve quality of life"

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Helping to develop educational tools for health professionals will support people with diabetes to manage their injectable therapies in the best way

Up to 24,000 diabetes-related deaths could be avoided each year in England if patients and doctors better managed the condition, a recent report by the NHS Information Centre (2012) has found. The report highlights poor management, such as not taking medication appropriately.
Around 2.75 million people in the UK have diabetes, and this is forecast to climb to four million by 2025 (Diabetes UK, 2008). Nearly 800,000 people with diabetes are estimated to use injectable therapies (BBC News, 2006). For these to work optimally, correct injection technique is essential. It is therefore vital to support health professionals in helping people with diabetes best manage injectable therapies.
Incorrect technique, including using the wrong needle length, can lead to therapies being absorbed in an unpredictable manner. This may cause immediate problems such as hypoglycaemia or hyperglycaemia, and ketoacidosis in type 1 diabetes.
Other consequences of injectable therapies, particularly insulin, not being administered correctly are lipohypertrophy (accumulation of fat under the skin), lipoatrophy (wasting of subcutaneous tissue) and bruising and bleeding at the injection site.
Longer-term complications relating to poor diabetes management can include heart or kidney failure, stroke and blindness. Diabetes treatment and complications cost the NHS approximately £1m per hour, or £9bn a year - about one tenth of the NHS budget (Diabetes UK, 2008).
Unfortunately, injection technique has not been emphasised in managing injection therapies. But it is the role of all health professionals to educate and treat people with diabetes, give training and advice on best practice, and regularly monitor their injection technique and injection sites.
Many people with diabetes do not remember receiving education on injection technique. While this does not mean they did not receive such education, it demonstrates that the way best practice is taught and refreshed needs to be improved.
In 2009, to raise awareness of this issue, a group of like-minded, experienced diabetes specialist nurses formed the Forum for Injection Technique (FIT). The forum is dedicated to establishing and promoting best practice in injection technique, and raising awareness of emerging and existing research relating to injection technique and the impact this may have
on health outcomes. FIT’s vision is to help those using injectable therapies to achieve the best health outcomes by ensuring the dose is delivered to the right injection site, using the right technique every time.
In October 2010, the first UK Injection Technique Recommendations for health professionals and people with diabetes who use injectable therapies was published by FIT (Training, Education and Research for Nurses in Diabetes UK, 2010). The recommendations cover topics such as needle length, bruising, pregnancy and insulin dosage.
Helping to develop educational tools for health professionals will support people with diabetes to manage their injectable therapies in the best way. FIT believes this can be achieved by implementing the UK injection technique recommendations, with supporting educational programmes for people with diabetes and health professionals.
FIT strives to examine practice within the field of injection technique, promote research in this field, develop initiatives to address areas of concern and encourage innovative approaches.

Debbie Hicks is nurse consultant, diabetes, Enfield Community Services, Barnet, Enfield and Haringey Mental Health Trust; chair, Forum for Injection Technique; and co-chair, TREND-UK

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