The truth about Rotating Insulin Injection Sites : How they can make a big difference - Essay Example

THE TRUTH ABOUT ROTATING INSULIN INJECTION SITES: How they can make a big difference Diabetes mellitus is defined as a disease in which the pancreas fails to secrete adequate levels of insulin to accommodate blood glucose levels. (FUNDAMENTALS OF NURSING: Standards and Practice, by Sue C. Delaune and Patricia K. Ladner) Due to the failure, insulin injections are necessary for diabetic care. In addition, there are a wide range and variety of complications arising from the disease. These lead to the close monitoring of the factors that affect insulin administration, including rotating insulin injection sites.

FEELINGS:There is a patient who was diagnosed for having Type 1 Diabetes since 1994. He is already an insulin dependent patient using Humulin N and/or Humulin R interchangeably or in conjunction with his other medications. He has used several injection sites such as his abdomen, thighs, buttocks, and arms. So far, he felt that injections in his abdomen are less painful and immediately effective. According to Diabetes Care 27 on Insulin Administration, “site selection should take into consideration the variable absorption between sites.

The abdomen has the fastest rate of absorption, followed by the arms, thighs, and buttocks.”EVALUATION:In several research studies and from medical practitioners who are experts on the field, rotation of injection sites is an important consideration for diabetic care. The table below shows the rationale and effects for rotating insulin injection sites:RATIONALE FORROTATIONEFFECTS OF NOTROTATINGSOURCES ORREFERENCES1. To prevent lipoatrophyLipoatrophy is a rare cutaneous side-effect that can develop at the site of insulin injection.

Diabetes Care 27:S106 -107S, Insulin Administration2. To decrease variability in absorption from day to day.Slow in absorption in the injection site.Diabetes Care 27:S106 – 107S, Insulin Admin.3. To prevent lipohypertrophyLipohypertrophy is an accumulation of fat cells that can make the skin look lumpy.Judy Kohn, RN, BSN, CDE abbottdiabetescae.com4. To minimize the chance of chronic tissue injuryChronic Tissue InjuryJohn B. Buse, MD, PhD, CDE, FACE, Assoc. Prof. of Medicine, Director, Diabetes Care CenterMedCare5.

To prevent fat atrophy in association with insulin antibodiesFat atrophy, while less common is more disfiguringWilliam H. Lamb, MD, FRCP, FRCPCH, Clinical Lecturer, Dept. of Child HealthMedCareDESCRIPTION:What then is the correct way to rotate insulin injection in the sites stipulated for effective diabetic care? Rotating the injection sites means “each injection should be at least a finger’s width away from the last one”. (Judy Kohn, abbottdiabetescae.com) Ms. Kohn recommended that a patient should inject in imaginary rows along the region, and to use up all the available sites in that region before returning to the original injection site.

Further, rotation also means injecting within one area (for example, the abdomen) rather than rotating to a different area (thigh, or arm, or buttocks) with each injection.CONCLUSION:The effect and rationale for rotating insulin injection sites have not been overemphasized. However, its awareness could prevent further medical complications associated with the disease. Diabetes, in general, is a difficult disease due to its management and complications. However, with proper diet, exercise, medications, and care, a diabetic patient could live a happy, normal life.

ACTION PLAN:The clinical practitioner, being aware of the effects of not rotating insulin injection sites, may follow the suggested action plan, as detailed below:1. Mentor the patient and the patient’s relatives on the correct method of rotating insulin injection sites.2. Emphasize the effects of not rotating the sites by using visual aids of the complications (lipoatrophy, hyperatrophy, fat atrophy, chronic tissue damage, among others).3. Identify the alternative injection sites available.4. Suggest methods of rotation (abdomen first, use a finger’s width away from last site)5.

Conduct regular audio-visual shows for diabetic patients for updates on diabetic care.SOURCES/REFERENCES:Gibbs Reflective Cyclewww.academicnurses.com/gibbs-reflective-cycle.htmlFUNDAMENTALS OF NURSING: Standards and Practice, 3rd edition by Sue C, Delaune and Patricia K. Ladner, Delmar Learning, 2006, Glossary of Terms, p. 1397Insulin Administration, Diabetes Care 27: S106 – 107S,care.diabetesjournals.orgJudy Kohn, RN, BSN,CDE abbottdiabetescae.comJohn B. Buse, MD, PhD, CDE, FACEAssociate Professor of Medicine, Chief, Division of General Medicine and Clinical Epidemiology, Director, Diabetes Care, University of North Carolina, Chapel Hill, NCMEDCAREWilliam H.

Lam, MD, FRCP, FRCPCHClinical Lecturer, Department of Child Health, the General HospitalBishop Auckland, UKMEDCARE