Liggins Institute, University of Auckland, Auckland, New Zealand.
Diabetes Care. 2010 Sep;33(9):1940-4. doi: 10.2337/dc10-0871. Epub 2010 Jun 28.
We aimed to establish the ideal injection techniques using 5-mm needles to reliably inject insulin into the subcutaneous fat in both children and adults and to quantify the associated pain and leakage of the test medium.
A total of 259 subjects (122 children/adolescents and 137 adults) were injected with sterile air corresponding to 20 IU insulin (200 microl) with 32-G 5-mm needles at 90 degrees or 45 degrees , in the abdomen and thigh, and with or without a pinched skin fold. Injection depth was assessed via ultrasonography. Subjects rated pain on a visual analog scale. Test medium injections into the abdomen and thigh (0.2-0.6 ml) were also administered to assess injection leakage.
Among children, 5.5% of injections were intramuscular (IM) and 0.5% were intradermal, while in adults, the incidence was 1.3 and 0.6%, respectively. The frequency of IM injections was greater in boys and negligible among adult women. Subcutaneous fat thickness was the primary predictor of the likelihood of IM injections (P < 0.001). A third of all patients reported experiencing no pain during insulin injection, with children/adolescents experiencing considerably more discomfort than adults. Some leakage of medium was observed, but was unrelated to injection volume and was generally minimal.
5-mm needles are reliably inserted into subcutaneous fat in both adults and children. These needles were associated with reduced pain and minimal leakage. We recommend an angled injection with a pinched skin fold for children, while in adults, the technique should be left to patient preference.
我们旨在建立使用 5 毫米针头将胰岛素可靠地注入儿童和成人皮下脂肪的理想注射技术，并定量评估相关疼痛和测试介质泄漏。
共有 259 名受试者（122 名儿童/青少年和 137 名成年人）接受了与 20 IU 胰岛素（200 微升）相对应的无菌空气注射，使用 32-G 5 毫米针头以 90 度或 45 度角在腹部和大腿处进行，同时有无捏皮褶。通过超声评估注射深度。受试者通过视觉模拟量表评估疼痛。还对腹部和大腿（0.2-0.6 毫升）进行了测试介质注射，以评估注射泄漏。
在儿童中，5.5%的注射为肌肉内（IM），0.5%为皮内，而在成年人中，发生率分别为 1.3%和 0.6%。男性中 IM 注射的频率更高，而成年女性中则可忽略不计。皮下脂肪厚度是 IM 注射可能性的主要预测因素（P<0.001）。三分之一的患者报告在胰岛素注射过程中没有疼痛，儿童/青少年的不适感明显高于成年人。观察到一些介质泄漏，但与注射量无关，且通常很小。
5 毫米的针头可可靠地插入成人和儿童的皮下脂肪。这些针头与减轻疼痛和最小泄漏有关。我们建议对儿童使用带捏皮褶的斜角注射，而对于成年人，应根据患者的喜好选择技术。
