Insulin Injections: Are You Doing It Wrong?
"A new study reveals common insulin administration errors by nurses and what you can do to ensure proper technique."
For individuals managing diabetes, insulin injections are a cornerstone of treatment. Administering insulin might seem straightforward, but it requires precision and adherence to established medical guidelines. A recent observational study published in the journal Diabetes Spectrum sheds light on the current practices of insulin administration by nurses in a northern Greek hospital, revealing some surprising shortcomings.
The study highlights a gap between recommended practices and actual implementation, raising concerns about the potential for suboptimal diabetes management. These findings underscore the importance of staying informed and vigilant about proper injection techniques.
This article will delve into the key findings of the study, offering insights into common errors and practical tips for improving insulin injection techniques, whether you're a healthcare professional or an individual managing your diabetes.
Why Technique Matters
Insulin therapy is crucial for people with Type 1 and advanced Type 2 diabetes. The effectiveness of diabetes therapy depends on correct insulin injection technique, yet improper use persists despite the convenience of insulin pens and established recommendations. Optimising injection technique includes improvements in delivery devices, teaching methods, monitoring, and complication management.
From Discovery to Personalised Care
Diabetes treatment has evolved through milestones spanning more than 3,500 years, from ancient Egyptian descriptions of “sweet urine” to modern continuous glucose monitoring and insulin pump therapy. The discovery and synthesis of insulin transformed treatment, while glucose testing helped patients share responsibility for managing therapy with physicians. A century after its discovery, insulin remains a cornerstone of diabetes treatment, alongside diet, physical activity, and newer technologies.
What the Research Says About Insulin Injection Practices
The observational study, conducted in a Greek public hospital, assessed the insulin administration practices of 20 nurses across two medical wards. Researchers used non-participant observation and post-hoc interviews to gather data, comparing the observed techniques against international guidelines. A total of 100 insulin administrations were observed, followed by interviews with eight of the nurses.
- Hand Hygiene: Only 61% of nurses washed their hands before administering insulin.
- Glove Use: 70% of nurses wore gloves during injections. However, gloves were not always changed between patients.
- Insulin Vial Preparation: A significant 64.5% of nurses did not clean the insulin bottle before inserting the needle.
- Air Bubble Check: 42.7% of administrations did not include a check for air bubbles in the syringe.
- Injection Site Assessment: In nearly 90% of cases, nurses failed to check the injection site for appropriateness or potential complications.
- Skin Antisepsis: While 90.9% cleaned the skin with an alcohol swab, the necessity of this step has been questioned in recent literature.
- Injection Angle: 70.9% of injections were administered vertically without creating a skinfold.
- Post-Injection Care: A staggering 89.1% of instances were rated as having poor post-injection care, with insufficient time allowed before needle withdrawal.
What Recent Studies Examine
Recent research continues to assess how insulin is taught and administered in clinical practice. A 2025 multicenter cross-sectional study of community nurses in a mountainous area of southwest Zhejiang, China, reported that institutional location, sex, knowledge of the latest guidelines, and insulin-injection training during the previous year were independent predictors of injection practice. Another cross-sectional survey in a northwest city of China examined patients’ injection techniques and the local complications associated with insulin injections. Research on nurses’ subcutaneous-injection preferences also questioned the evidential basis for routinely disinfecting skin before insulin injections.
When Individualisation Falls Short
An observational study of insulin administration by nurses in Northern Greece found that individualized patient assessment was practiced when selecting a 45° or 90° needle angle according to body structure. However, this adjustment was not accompanied by the recommended creation of a skinfold for injection. The finding shows that tailoring one part of technique does not necessarily mean that all recommended steps are being followed.
Pressure and Syringe Variables
A study of syringe-pump injection pressure compared different syringe volumes and speed settings. With 30 ml syringes, injection pressures fluctuated in most of the six syringe pumps when the speed was below 5 ml.h-1. This indicates that syringe volume and pump-speed settings can affect pressure stability in syringe-pump delivery.
Practical Tips for Improved Insulin Injections
Whether you're a healthcare provider or managing your own diabetes, adopting best practices for insulin injection is crucial. Here's a concise guide:
Refreshing Established Guidance
The Forum for Injection Technique and Therapy Expert Recommendations, known as FITTER, brings together physicians, nurses, diabetes educators, certified diabetes care and education specialists, and other allied healthcare professionals. FITTER Forward provides an evidence-based refresh of the 2016 injection-technique recommendations, drawing on a literature review and expert consensus. The updated recommendations address advances in insulin-delivery technology while retaining widely established key messages.
Innovation, Education, and Partnerships
The 2025 Injection Technique Matters guidance presents innovation, education, and strong community partnerships as routes to advancing insulin-delivery standards. The initiative is supported by embecta, which states that it is committed to improving injection technique and outcomes for people living with diabetes. This future-facing approach links technical progress with education and community collaboration.
Quality Improvement in Practice
A 2026 study examined insulin-injection practices at the primary community level using questionnaires and targeted data analysis. It implemented a special quality-management program for continuous improvement, with the aim of enhancing injection standardization and evaluating its effectiveness in a real-world community setting. A separate 2022 study assessed patients’ insulin-injection practices and examined their effect on glycemic control.