Practical aspects of insulin administration: what the healthcare provider knows

Figures & data

Figure 1: Curriculum and structure of Diabetes 101 Workshop. Image credit: Own image.

Table 1: Topics and list of knowledge-based questions with model answers

Item	Memorandum answer
Section 1: Insulin characteristics and initiation
Question 1: Insulin should be initiated under which of the following conditions:
a. Random blood glucose is ± 11.1–16 mmol/l at diagnosis	INCORRECT
b. Fasting blood glucose is ± 15 mmol/l or more	CORRECT
c. HbA1c is more than 10% at diagnosis	CORRECT
d. HbA1c is more than 7% on maximum oral therapy	CORRECT
Question 2: Examples of cloudy (milk-like) insulin are:
a. Actrapid® (yellow coded)	INCORRECT
b. Protaphane® (green coded)	CORRECT
c. Actraphane® (brown coded)	CORRECT
Question 3: Cloudy insulin should be properly ‘mixed’ before use
a. Shake it until an even milky colour	INCORRECT
b. Tip 10 times OR roll 10 times	INCORRECT
c. Tip 10 times AND roll 10 times	CORRECT
Section 2: Preparation and administration
Question 4: The correct method for priming a pen:
a. Inject ± 2 units of insulin upwards once only	INCORRECT
b. Priming is needed only when using a new needle	INCORRECT
Question 5: Longer needles (e.g. 8–12.7 mm) should be used for obese patients	INCORRECT
Question 6: Absorption rate of human insulin is faster from abdomen than from thighs	CORRECT
Question 7: In adults: Lifting a skinfold while injecting is always necessary	INCORRECT
Question 8: When using a pen for insulin administration:
a. Plunger should be pressed down from 3 to 5 counts	INCORRECT
b. Needles should be removed from pen directly after each injection	CORRECT
c. Needles of insulin pens should ideally be used once only	CORRECT
d. Insulin pens in use should be stored at room temperature	CORRECT
Question 9: Once in use, insulin vials should be discarded after 28 days	CORRECT
Question 10: When using syringes: Air is injected into vial before drawing up the insulin to ease process	CORRECT

Note: HbA1_c = glycated haemoglobin.

Table 2: Designation of healthcare professionals who completed questionnaires

Variable	Overall, n (%) (n = 146)
Healthcare professional designation:
Medicine Registrar	32 (22)
Medicine Medical Officer	30 (21)
Medicine Consultant	8 (5)
Medical Intern	45 (31)
Nursing practitioner	31 (21)

Table 3: Summary of responses of participants to questions before and after diabetes workshops

	Pre-training (n = 146)		Post-training (n = 146)
Questions	Correct, n (%)	Incorrect, n (%)	Correct, n (%)	Incorrect, n (%)	p-value
Q1. Insulin initiation in T2D:
a. RBG 11.1–16.0 mmol/l	60 (41)	86 (59)	77 (53)	69 (47)	0.046
b. FBG ≥ 15 mmol/l	41 (28)	105 (72)	70 (48)	76 (52)	< 0.001
c. HbA1c > 10% at diagnosis	37 (25)	109 (75)	101 (69)	45 (31)	< 0.001
d. HbA1c > 7% on max oral therapy	76 (52)	70 (48)	77 (53)	69 (47)	0.907
Q2. Examples of cloudy insulin:
a. Actrapid®	35 (24)	111 (76)	73 (50)	73 (50)	< 0.001
b. Protaphane®	75 (51)	71 (49)	124 (85)	22 (15)	< 0.001
c. Actraphane®	55 (38)	91 (62)	116 (79)	30 (21)	< 0.001
Q3. Correct re-suspension of insulin	33 (23)	113 (77)	139 (95)	7 (5)	< 0.001
Q4. Method of priming pen:
a. Inject ± 2 units insulin into air once only	30 (20)	116 (80)	25 (17)	121 (83)	0.450
b. Priming needed only when using a new needle	25 (17)	121 (83)	88 (60)	58 (40)	< 0.001
Q5. Longer needles for obese patients	62 (43)	84 (57)	115 (79)	31 (21)	< 0.001
Q6. Absorption faster from abdomen	50 (34)	96 (66)	129 (88)	17 (12)	< 0.001
Q7. Lifting skinfold in all whilst injecting	57 (39)	89 (61)	91 (62)	55 (38)	< 0.001
Q8. When using a pen:
a. Plunger pressed down 3–5 counts	19 (13)	127 (87)	74 (51)	72 (49)	< 0.001
b. Needles removed after each injection	46 (32)	100 (68)	125 (86)	21 (14)	< 0.001
c. Single usage of needles	72 (49)	74 (51)	115 (79)	31 (21)	< 0.001
d. Stored at room temperature if in use	67 (46)	79 (54)	132 (90)	14 (10)	< 0.001
Q9. Insulin vials discarded after 28 days	112 (77)	34 (23)	132 (90)	14 (10)	0.002
Q10. Air injected into vial before drawing up insulin	46 (32)	100 (68)	82 (56)	64 (44)	< 0.001

T2D = type 2 diabetes; RBG = random blood glucose; FBG = fasting blood glucose; HbA1c = glycated haemoglobin.