Abstract
Purpose: Insulin injection is an important treatment in diabetes, but its procedures are complicated and it may reduce the quality of life of diabetic patients. This study was designed to determine how diabetic patients suspend their neutral protamine Hagedorn (NPH) insulin at self-injection. Methods: The subjects were 55 diabetic patients (27 men and 28 women) who perform NPH insulin self-injection using a pen-type injection device. We used a questionnaire to interrogate them about their self-injection of insulin, focusing especially on the suspension. We examined whether the duration and uniformity of the insulin mixture, based on the frequency with which they tip and roll it, are correlated with the level of HbA1c, and with the frequency of nocturnal hypoglycemia. Results: 95% of the patients answered that they tip and roll their NPH insulin at self-injection,and 91% do not mind the time and effort involved. 87% of patients confirmed that NPH insulin is suspended adequately before self-injection. However, 63% of patients replied that they tip and roll their NPH insulin less than 10 times, and 71% do so for less than 10 seconds. The level of HbA1c did not correlate significantly with the number of times or the duration of agitation of the insulin mixture. The number of times and the duration did not differ significantly between patients who experienced nocturnal hypoglycemia and those who did not. Conclusion: It is speculated that not many patients agitate their NPH insulin suspension satisfactorily. Our questionnaire appears to be effective in finding those patients who do not tip and roll their NPH insulin correctly. Certified diabetes educators should ask patients how they tip and roll their NPH insulin at the time of self-injection and instruct them in the correct procedure.
