On the occasion of 99th anniversary of Insulin Injection Day, Forum for Injection Technique & Therapy Expert Recommendations (FITTER) India experts advised to adopt correct insulin injection technique especially in view of the fact that diabetes gains further significance during COVID-19 pandemic.

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FITTER is a panel of experts who along with BD-India, support people with diabetes to achieve the best possible health outcomes with correct injection technique. Insulin therapy is often a crucial part of diabetes management. Type 2 diabetes patients ultimately may require insulin therapy in the course of the disease for effective glycaemic control. Injection technique therefore remains crucial in the process. Some of the recommendations from the Forum for Injection Technique & Therapy Expert Recommendations (FITTER) India are listed below:

Many people repeatedly use certain preferred injection sites to inject insulin or even reuse syringes on themselves without realizing the complications that may arise due to this incorrect insulin administration. During the COVID pandemic, it is imperative for healthcare professionals to be more aware in advising their patients on complications that may arise due to incorrect insulin administration practices.

"There is a bidirectional relationship between COVID-19 and diabetes. On the one hand, diabetes is associated with an increased risk of severe COVID-19, on the other hand, new-onset diabetes and severe metabolic complications of pre-existing diabetes including diabetic ketoacidosis and hyperosmolarity which necessitates exceptionally high doses of insulin in our patients," said Dr (Prof) Hemraj B Chandalia, Professor and Director, Dept. of Endocrinology, Diabetes Endocrinology Nutrition Management and Research Centre (DENMARC), Mumbai, FITTER India Scientific Advisory Board member.

A study indicates that those with both type 1 and type 2 diabetes are at greater risk for COVID-19 hospitalization and illness severity than people without diabetes. Hence, enhanced care for diabetes patients during the pandemic is paramount. Patients must be extra cautious of storing, using and injecting insulin correctly and safely. Concerned about safe injection practices for people with diabetes, the experts also emphasized that incorrect insulin injection technique could lead to lipohypertrophy, a thickened, rubbery swelling under the skin at the patient's usual injection sites. If the patient injects into lipo, their body may not absorb the insulin smoothly and consistently.

"Utmost care must be taken by patients when injecting insulin. One should opt for single use insulin syringes preferably to curb the risk of infections or any complications due to incorrect injection technique. Multiple reused needles can damage tissues, leading to dosage inaccuracy, and can put patients at a significant risk of developing lipohypertrophy. With COVID putting a renewed focus on patient safety, there is a growing need to make them more aware of the correct insulin administration practices. Such awareness can go a long way in ensuring reduced complications in people with diabetes," said Dr Ganapathi Bantwal, Dept of Endocrinology St John's Medical College & Hospital, Bangalore, President Endocrine Society of India, FITTER India reviewer panel.

"Awareness on correct insulin administration technique plays a critical role in therapy adoption, adherence and management of diabetes. While prescribing insulin therapy, physicians' role is not restricted to deciding the dosage and timing of insulin but goes onto counseling the patients around selecting the correct site, selecting the right device and appropriate usage. Most patients don't fully comprehend why they should ideally use a new needle for every injection. The lack of doing so can lead to complications that can worsen their medical conditions; more so during this pandemic," said Prof Subhankar Chowdhury, Professor and Head, IPGME&R & SSKM Hospital, Kolkata.

FITTER India seeks to promote evidence-based clinical best practice, safety and self-care of diabetes injectable and infused therapies which will lead to improved health outcomes, well-being, lower healthcare costs and reduced burden on care providers and society. Implementation of these recommendations may have a direct impact on the health outcomes of individuals living with diabetes who require injection & infusion therapy.