Injecting Insulin Through Clothing
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Friday, March 31, 2006 |
Q: "A friend told me that he injects his insulin through his shirt into his abdomen. Is this practice safe? Is this practice common? I would think that a danger exists in pushing cloth fibers into the skin from the shirt. At the very least he might develop a hole or small embarrassing blood spot on his shirt."
A: Some people reading your question will be shocked, while others will respond, "of course it's ok-I do it all the time!"
Let me provide some references to help you understand the issues:
In the American Diabetes Association's Clinical Practice Recommendations, many details of insulin injections are reviewed (needle reuse, pen use, bubbles in the syringe, angle of injection, pre-filled syringes, injection sites, the recommendation to have a clean injection site not necessarily requiring topical alcohol). However, there is no mention of injecting through clothing.
The first mention of this practice that I'm aware of was in Practical Diabetology, Mar/Apr 1988, in the article "Insulin on the Go" by Lois Jovanovic, M.D. She wrote, "…it may be necessary either to inject through clothing or to try to hide the process of baring a suitable spot and giving an injection under the table. Under such conditions, the use of an alcohol swab is virtually impossible. (Personally speaking, however, the only purpose of an alcohol wipe is to increase pain of injection. Injecting directly through clothing facilitates public injection and has not caused any reported cases of infection)."
Diabetes Care, March 1997 reported in the article, "The Safety of Injecting Insulin Through Clothing" that "it is safe and convenient to inject insulin through clothing." This study was then reported in Diabetes Forecast, June 1997. Scott Jacober, an endocrinologist with diabetes, had been injecting through his clothes for years. His nurse educator, Doris Fleming, was at first taken aback at this practice. So Jacober, Fleming and their colleagues did a study at Wayne State University in Detroit and the University of Michigan in Ann Arbor.
- Forty-two people with either type 1 or type 2 diabetes first used conventional technique (wiping skin with alcohol) for 10 weeks. For the second 10 weeks, subjects were instructed to use the technique of injecting through one layer of fabric for at least one of their injections. Over the course of the study, there were 7,275 injections made through clothing.
- There was no sign of skin problems at the injection sites, and blood glucose control was not affected by injecting through clothes. Subjects reported the liberation and convenience with this practice, although some reported difficulty injecting through thick fabric such as denim, as well as sometimes small bloodstains formed on the clothes.
- The authors further commented on the unnecessary practice of cleansing the skin with alcohol: "…there have been few incidences of infections reported, the number of bacteria carried through a small-gauged needle used in injecting insulin is well below that needed for infection to occur, most insulin preparations have…additives that inhibit bacteria growth…"
- The authors concluded that "injecting through clothing offers little risk of complications and can simplify an already complex diabetes regimen…(but) obviously if your skin (or clothing) is dirty, you'll want to clean your skin first…just use common sense."
"Mail Call" in Diabetes Forecast, August 1997, explored this study further, because so many people voiced concerns about this practice. Issues presented in a letter from Joan MacCracken, MD included:
- Participants in the study were educated adults; one cannot automatically assume this is safe for children who play hard, often in dirt, and who may not bathe daily.
- Denim jeans, or school uniforms, may not be cleaned frequently; children often use their clothing as "napkins."
- She reported on a teenager admitted into the hospital for an abscess requiring surgical drainage-this teen had been injecting insulin through his clothing.
- Some people occasionally complain about insulin leakage-sometimes due to pinching the skin too tightly or using the new, shorter needles. If injecting through clothing, this leakage will not be noticed.
- People are less likely to check for lipohypertrophy (lumpy areas at the injection site) when clothes hide the injection.
- She voiced concerns during colder weather when people may wear several layers and/or thicker clothing.
- Conclusion: So there you have it. There are pros and cons to this practice. I doubt that there will ever be an "official" recommendation to inject through clothing, due to the above-mentioned variables that should be considered. I'd encourage you to discuss this with your diabetes educator and your physician.
Related Links
Children with Diabetes
http://www.childrenwithdiabetes.com
Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
All tradenames and trademarks not owned by Abbott Laboratories are the property of their respective owners. For details on tradenames and trademarks and their respective owners, visit the non-Abbott trademarks listing.
