New injection recommendations for patients with diabetes

Diabetes Metab. 2010 Sep;36 Suppl 2:S3-18. doi: 10.1016/S1262-3636(10)70002-1.


Aim: Injections administered by patients are one of the mainstays of diabetes management. Proper injection technique is vital to avoiding intramuscular injections, ensuring appropriate delivery to the subcutaneous tissues and avoiding common complications such as lipohypertrophy. Yet few formal guidelines have been published summarizing all that is known about best practice. We propose new injection guidelines which are thoroughly evidence-based, written and vetted by a large group of international injection experts.

Methods: A systematic literature study was conducted for all peer-reviewed studies and publications which bear on injections in diabetes. An international group of experts met regularly over a two-year period to review this literature and draft the recommendations. These were then presented for review and revision to 127 experts from 27 countries at the TITAN workshop in September, 2009.

Results: Of 292 articles reviewed, 157 were found to meet the criteria of relevance to the recommendations. Each recommendation was graded by the weight it should have in daily practice and by its degree of support in the medical literature. The topics covered include The Role of the Professional, Psychological Challenges, Education, Site Care, Storage, Suspension and Priming, Injecting Process, Proper Use of Pens and Syringes, Insulin analogues, Human and Pre-mixed Insulins, GLP-1 analogs, Needle Length, Skin Folds, Lipohypertrophy, Rotation, Bleeding and Bruising, Pregnancy, Safety and Disposal.

Conclusion: These injecting recommendations provide practical guidance and fill an important gap in diabetes management. If followed, they should help ensure comfortable, effective and largely complication-free injections.

Publication types

  • Practice Guideline
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Blood Glucose / metabolism
  • Child
  • Consensus Development Conferences as Topic
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / drug therapy*
  • Diabetes Mellitus, Type 1 / drug therapy
  • Drug Storage
  • Evidence-Based Medicine
  • Expert Testimony
  • Female
  • Humans
  • Hypertrophy / etiology
  • Hypertrophy / prevention & control
  • Hypoglycemic Agents / administration & dosage*
  • Injections, Subcutaneous* / adverse effects
  • Injections, Subcutaneous* / instrumentation
  • Injections, Subcutaneous* / methods
  • Injections, Subcutaneous* / psychology
  • Insulin / administration & dosage*
  • Insulin / analogs & derivatives
  • Needles
  • Needlestick Injuries / etiology
  • Needlestick Injuries / prevention & control
  • Patient Education as Topic
  • Pregnancy
  • Pregnancy Complications / prevention & control
  • Subcutaneous Fat, Abdominal / injuries
  • Subcutaneous Fat, Abdominal / pathology
  • Syringes


  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin