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Insulin injections: Does needle length matter?

Most of us aren't crazy about needles, and many people just plain freak out around needles. Recently, I had a patient tell me, "I've had diabetes for 19 years, and I still have trouble with the needles and insulin injections — I even have a couple of tattoos!"

In years past, we diabetes educators at Mayo Clinic in Rochester, Minn., promoted the longer, 1/2 in. (12 mm) insulin injection needles for our overweight patients. But we've recently adjusted our recommendations after doing a literature search for peer-reviewed studies and publications on needle length published last year. Our questions as we did this search were:

  • Should the choice of needle length depend on skin thickness or fatty tissue thickness?
  • Will a shorter needle length increase a person's satisfaction and compliance?

What we found is that the shorter, less intimidating, needles of 5/16 in. (8 mm) provided the same blood glucose control as the longer, 1/2 in. (12 mm) needles, with no increase in insulin leakage at the site. Those studied also reported less pain and increased satisfaction.

We now recommend that overweight or normal weight adult individuals use the shorter 5/16 in. (8 mm) insulin syringe needle. However, technique is important when injecting insulin and can make a big difference in the absorption and dosing. The preferred injection site is the abdomen, although other sites can be used. And a person should inject straight in at a 90-degree angle, holding the needle in place for a count of 10 before removing. Very lean people using 5/16 in. (8 mm) needles may need to pinch the skin and inject into a skin fold to prevent the possibility of injecting into muscle. Individuals already using the 1/2 in. (12 mm) needles should also use a skin fold.

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