Inadvertent intramuscular injection risk with subcutaneous insulin injections and risk predictors in adults: a cross-sectional sonographic study

U. A. Liyanage, Y. Mathangasinghe, C. K. Liyanage, E. S. Wijewickrama, D. Mahathanthila, A. J. Dharmawansa, S. Jeyerajesingham, D. S. Warapitiya, M. D.M.S. Wijayabandara, B. C.T.A.N.W.M.R.C.S. Kempitiya, A. Aravinthan, L. M.D.T. Jayasekara, N. Gunawardena, W. K. De Abrew

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The use of inappropriately long needles for subcutaneous insulin injection increases the risk of inadvertent intramuscular injection. Aims: To estimate the inadvertent intramuscular injection risk at potential subcutaneous insulin injection sites and to identify the determinants of this risk in adults. Methods: A descriptive cross-sectional study was conducted on adult patients between the ages of 18 and 70 years who were admitted to the National Hospital of Sri Lanka. Skin-to-muscle distance and dermal thickness of potential insulin injection sites were measured using ultrasonography to estimate the intramuscular injection risk. Results: A total of 185 patients were included in the study. The estimated risk of inadvertent intramuscular injections with insulin needles of any length was considerably higher at the mid-arm and mid-thigh compared to the abdomen. The risk of inadvertent intramuscular injection was approximately 60% with 13-mm needles without a skin fold at the arm and thigh. The abovementioned risk was approximately halved when the needle length was 8 mm. We developed formulae to predict the skin-to-muscle distance with or without a raised skin fold based on assigned sex at birth and anthropometric parameters. Conclusions: There is a high inadvertent intramuscular injection risk with currently used needles (8 and 13 mm) with U-100 syringes in our population even with a raised skin fold. To minimize this risk, 13-mm needles should be avoided when injecting insulin subcutaneously especially to the limbs. Sex and anthropometric parameters can be used to predict the distance from skin to muscle surface; hence, the selection of needle length could be personalized based on the derived formulae.

Original languageEnglish
Pages (from-to)731-736
Number of pages6
JournalInternational Journal of Diabetes in Developing Countries
Volume43
Issue number5
DOIs
Publication statusPublished - Oct 2023

Keywords

  • Intramuscular injection risk
  • Needle
  • Sri Lanka
  • Subcutaneous insulin
  • Subcutaneous soft tissue thickness prediction
  • Ultrasound

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