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Short needles vs long needles vs both?

Discussion in 'Adults with Type 1' started by SPICYSMOM, Jan 24, 2011.

  1. SPICYSMOM

    SPICYSMOM Approved members

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    I was given the short pen needles. Sounded good right?

    But I was just reading in the THINK LIKE A PANCREAS on page 57:

    If you are very lean, choose a short pen needle (5-8mm). If you have adequate body fat, choose a longer needle (10-12mm)...........If you are overweight, "short" (5-8mm) needles may not inject the insulin deep enough to achieve proper absorption. ......If you have plenty of body fat, use standard-lengh needles. If you have difficulty pinching up an inch or more of body fat, use short needles.

    Needless to say, my legs are alot leaner than my abdomen. So I went out and picked up a box of BG originals - 12.7mm! Pink paper on the tips will let me know those are for the abdomen. This might explain why I have variable control.

    Has anyone else had this situation?
     
  2. sarahspins

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    Interestingly, needle manufacturers state that ALL people can use short needles.. the thickness of your actual "skin" is the same, it's just the sub-q layers that differ.

    I am not skinny, and I use the 5mm needles when I'm on MDI with no problems... I am currently using 6mm needles on my pump sets... I don't personally notice a difference between these and the longer ones, except the longer ones tend to hit muscle more often (which hurts - I put sets on my outer thighs a lot, which probably have less fat than the rest of me).
     
    Last edited: Jan 24, 2011
  3. TheFormerLantusFiend

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    Think Like a Pancreas is plain old wrong. Here's a study that tried to debunk that theory by actually measuring the skin thickness of a whole bunch of people, including many who were obese. It found that none of them had skin thick enough that a short needle would go into skin if the person did not pinch.

    Skin and subcutaneous adipose layer thickness in adults with diabetes at sites used for insulin injections: implications for needle length recommendations
    by Michael A Gibney, Christina Arce, Karen Byron, and Laurence Hirsch of the BD company.
    http://informahealthcare.com/doi/abs/10.1185/03007995.2010.481203
     
  4. Jordansmom

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    We had a popular Pediatric Endo speak at family camp. At one point he went off on a tangent about the new "nano" needles and short needles. He said he sees huge variability in doses needed for short needles versus regular and that he won't prescribe nano needles at all even for his smallest, or thinnest patients.

    I have no experience myself.
     
  5. TheFormerLantusFiend

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    As a P.S.
    I am an extremely skinny person- smaller than the smallest person in the study I cited above. That study pointed out that doing injections at a 90 degree angle with even a 4mm needle would mean going into muscle for the smallest people they studied. That bugged me, especially because when I inject with 5mm and especially 8mm needles I often feel a second layer of resistance as I put the needle in.
    I got a sample baggie of 4mm needles from my endo and I loved the feel of them and I did not have any problems with them. I could feel the difference- it felt like that last ouch part at the end of my shots was missing. I kept thinking I must have messed up because there was something missing. But my blood sugar following those doses was same as always. None of the shots went into skin (something I have accidentally done a few times when injecting my butt- I think it's harder to figure out the angle there).
    I am using up my boxes of 5mm needles but after that I'm going with the 4mms.
     
  6. SPICYSMOM

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    Great study on needle lengths

    Interesting conclusion.

    I have bought the 12.7mm needle tips for use in the abdomen, and will keep using them until they are gone. I have the 8mm for my legs.

    I am going to bring your study to my CDE and see what her experience is with patients.

    Thanks for the input.
     
  7. Ronin1966

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    Hello SPICYSMOM:

    The short needles

    a) won't begin to go through my clothing the way the long needles will :cool:

    b) short needles will get bent FAR more easily on my "iron skin". After 40 years there is literally no place that has not been WELL used. I rotated zealously since the "dark ages", did not matter.

    Still have patches that will scare the heck out of young nurses :D
    Haven't used some "targets"/body parts for over a decade, have never returned to ~soft skin~.
     
  8. TheFormerLantusFiend

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    a) Good point. I very rarely inject through clothes since I like to see where I'm putting the needle and also worry about what is on my clothes- they're not always really clean :eek:

    b) Wow, none of my bent needles got bent on my skin. I would hope for the thin needles to leave less scar tissue in the first place, but injecting through scar tissue probably does make a longer needle more worthwhile anyways. I have so few scars that they are easy to avoid.
    Have you tried any non-standard places to inject? I use my calves.
     
  9. SPICYSMOM

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    May clinic recommends long needles for overweight folks

    I found on the Mayo clinic website an article: Insulin injections: Does needle size matter? http://www.mayoclinic.com/health/insulin-injections/MY01287

    It states the short needle is generally not suitable for people who are overweight because a too-shallow needle may result in insulin backtracking from the injection site, causing an inaccurate insulin dose. They recommend the long/standard length to overweight patients if they are using the short needle., they often see improvement in BG results. As diabetic educators, we don't have scientific evidence to support this claim, but personal observation generally validates our recommendations.
     
  10. TheFormerLantusFiend

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    No study can show what will or won't work for you.

    But I don't think highly of that article. The person writing it is going on gut. And she doesn't seem to know that jet injectors had been out for more than ten years by the time that article was published (I first met somebody using one right after I was diagnosed, and she'd been using it for six years at the time).
     
  11. sarahspins

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    If you follow the logic that overweight = insulin resistance = large doses, sure.. but for the average T1 (even with "some" IR) I don't personally think this is an issue... we aren't generally taking 20+ units at a time, as many T2s are.
     
  12. garyscheiner

    garyscheiner New Member

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    Needle length

    When I wrote Think Like A Pancreas back in 2004, the commonly held belief in the healthcare field was that heavier people needed longer pen needles. It is true that recent research has shown the skin thickness to be very similar between people. Short pen needles will get the insulin below the skin, but there can be a problem with leakage back to the skin surface when taking large doses. Keeping the needle in the skin for several seconds after injecting remains important.

    It is reasonable to start out with a short needle (on pens or syringes), but if problems occur with absorption or leakage, I would recommend going to the next longer needle, and repeat until the problem is eliminated.
     
  13. SPICYSMOM

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    Hi - glad to have you on our forums.

    When do you think you will be updating your THINK LIKE A PANCREAS to the next version?

    Off topic: Is it okay to take Lantus at 6 am - then at 9 pm rather than 6 pm. Or is it necessary to have them at 6 pm and 6 pm?

    Thanks,
     
  14. Ed2009

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    Maybe I'm missing something: Do you guys really inject through clothes?, or it is just a funny comment?

    Our endo is hammering on having the spot of skin very clean (which is unlikely to happen with clothing).

    I ask because I 've never listened/read to something like that before.

    Thanks in advance for clarifying.
     
  15. TheFormerLantusFiend

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    Most of the adult diabetics I know who use shots inject through clothes. It is discrete and it gets the insulin in.
    It may or may not cause more scarring, it can certainly cause more site infections, it requires that the person have long enough needles to go through clothes plus skin, it makes it harder to get a pinch, it makes it impossible to visually check that you're not injecting a bruise, and it increases the odds that you'll bleed on your clothes.
    Also, you need to have fairly thin clothes for this to work and I wear two or more shirts when I'm out and about plus a thick pair of pants.
    That's part of why I inject my calves.

    I'd say injecting through clothes is way better than not injecting but it's better not to go through clothes.
    It's better to have clean skin, but a shot with dirty skin is better than no shot (unless maybe the dirt on the skin contains blood or snot from another person).

    Your endo wants to prevent infection and he may be concerned about scar tissue forming but frankly most medical professionals are more concerned about this than is really warranted.
    That is because their own experiences with injections are in settings where it's a lot more possible and likely for people to catch things from each other- settings where multiple people are getting injected, lots of people have contagious illnesses, etc.
     
  16. SPICYSMOM

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    I remember reading about injecting thru clothes from a book I read years earlier by Dr. Bernstein. I found the following link at etalk: http://presentdiabetes.com/etalk/Insulin-injection-through-t1697.html

    Dr. Mona Morstein said in her comment: "Dr. Richard Bernstein, of "Dr. Bernstein's Diabetes Solution" book, who is a T1DM x 65 years, and my diabetic mentor, says it's perfectly fine to inject through clothes and he does so all the time, and allows patients to. He carries around a little vial of H202, which he says removes blood from clothes immediately if that happens with the injection. I let patients injecty through clothes if they wish."

    I had not thought of taking the water to break up the little stain, but it might not hurt.
     
  17. Ed2009

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    Well, thank you for educating me.

    I'd never thought even in my wildest dreams that injecting through clothes was kosher!

    Anyway, I won't tell the kid for the time being, he can try it by himself when he grows up. I hope I won't get an answer like: "Dad, you knew all these years and never told me!"
     
  18. Ali

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    As a long time T1 i never injected through clothes (when I was on shots and not the pump). I really can not imagine that being a very good thing to do for lots of reasons. It is not that difficult to find a bathroom or discreet area or to find a patch of bare skin when at a table. Ali
     
  19. Tim44

    Tim44 New Member

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    forced to use short needles

    I ran out of my old Humalog pens two weeks ago and had to switch to the new "Kwikpen" from lilly. Very disturbing as the new pens DON'T LET YOU KEEP THE NEEDLE ON unless you use the super short needles. I know bd says you should never do this, but I've been using pens for over 10 years and never had a problem.

    The beauty of the old pen is you could carry it with you everywhere with the needle on. Need a shot? Just take it out and quick as can be give yourself a shot. All the switching needles around, etc could be done later.

    So now I'm using the ultra short 5mm 31G needles and they simply don't work. Not enough insulin getting through my tough skin and ample body mass. I'm a large guy (260 lbs) and going on my 21st year of type-1 so my soft spots are pretty tired. Have others have this problem too? Is there a Humalog pen out there that allows you to keep the needle on?

    Needless to say, it's been a hard two weeks.
     
  20. Tim44

    Tim44 New Member

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    going through clothes

    I've been doing it for years. Comes in handy, especially when out at dinner or similar social event. Wouldn't recommend it as a regular thing, make sure the needle is long enough. Never do it if you're wearing dirty pants and don't use the needle again.
     

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