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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:
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.
Sara J. Carlson, R.N., C.D.E.
Peggy Moreland, R.N., C.D.E.
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I have recently changed my Victoza needle 32G Fine from 6mm to 4mm and found that the fasting BG is getting controlled better. I have searched literature a(PubMed/MedLine) nd could not find any papers addressing this. Perhaps the pharma companies may have this information of correlation between needle length and absorption. I have a BMI of 29 and still 4mm appears to be just sufficient. Victoza website says that there is no difference between the 4 mm and 6 mm lengths. I have noticed that occasional hematoma with 6mm needles that happen due to quicker injection speed do not happen in 4 mm ones. Just wanted you to be aware of this. 4mm needles are much less painful and I prefer them.
In an article posted 5-6 months prior to this one, the author recommends 4mm-6mm, 31-32 gauge syringes for everyone.
She cites a study that found everyone's skin thickness is about the same, whether thin or obese.
The author cites a second study verifying the effectiveness of 4mm-5mm syringes:
Wendy, Try the 4 mm: don't pinch and go straight in and if it is not affecting your blood glucose you can stay with the shorter needle.
My personal pharmacist talked me into longer needles and I use 8 mm. I am obese, especially in the abdomen. But my dietitian and the pharmacist at work are suggesting I switch to 4 mm.
I use a mini needle (not micro) and have found that pinching up really helps, both on my stomach and on my thigh. It's difficult to remember to wait those ten seconds after the injection when one is in a hurry. Thanks for the reminder.
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