Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-85

Syringe/pen needle reuse and sharps disposal Manufacturers and FIT Forum for Injection Technique Canada 2017 recommend the syringe/pen needle be used only once to ensure its sterility, reduce the risk of infection, clogging, needle breakage in the skin, complications (lipohypertrophy) and inaccurate dosing. For people who choose to reuse syringes/pen needles, it is best to use sterile technique when recapping and to remove the needle in between injections. Pen needles that are left on between injections can allow air to enter the cartridge, resulting in air bubbles that may reduce the insulin flow rate from the pen. Individuals should be instructed to assess for redness, swelling or irritation and to contact their health-care provider should they have any concerns. Disposal of needles : All used sharps (pen needles, lancets, syringes) should be placed in a puncture-resistant container and disposed of according to local regulations. Steps to performing an injection It is essential the health-care professional help people with diabetes explore their feelings, fears and concerns related to insulin initiation and self-injection. Motivational interviewing and empowerment strategies can help determine the individual’s readiness for injectable or insulin therapy, assist individuals to make choices and overcome their fear of self-injections (see Chapter 11: Self-Management Education & Support: Program Developement). Clinical practice has shown people with diabetes benefit from doing a dry or saline injection under the supervision and support of a diabetes educator. Positive encouragement and hands-on practice assist the individual in overcoming the mental and emotional fears about injections and helps to provide confidence that he or she can continue this self-management skill at home. Insulin and other injectable therapies should be injected into the subcutaneous adipose tissue to ensure consistent and predictable absorption (151). Each of the company pen monographs provides step-by-step pictorial instructions on the use of their pen. The educator can use the instructions as a teaching tool, recording any additional information on the document and encouraging the individual with diabetes to refer to it at home. Please consult the FIT Forum for Injection Technique Canada: Recommendations for Best Practice in Injection Technique (149). The following information should be emphasized when discussing insulin administration: • Bolus insulin: Pre-prandial administration of the bolus results in better postprandial control and therefore the recommended timing of injecting insulin is as follows (24): o Rapid-acting insulin: 0 to 15 minutes prior to meals.