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New FIT diabetes injection ‘Golden Rules’

The Forum for Injection Technique (FIT) UK, which provides evidence-based best practice recommendations on diabetes injection technique, has published the latest edition of its UK Injection and Infusion Technique Recommendations, including for the first time a new set of six ‘Golden Rules’.

The UK Injection and Infusion Technique Recommendations 4th Edition covers key aspects of injection technique such as the importance of using short pen needles, recommended injection sites, and how to avoid lipohypertrophy (a thickened, ‘rubbery’ lesion associated with factors such as incorrect rotation of sites and needle reuse), as well as guidance on the psychological challenges of injections, therapeutic education, and injection safety.

Included in the document are a new set of key ‘Golden Rules’ on:

  1. Psychological issues around insulin therapy and administration
  2. Injection technique in adults
  3. Injection technique in children and young people
  4. Treating and preventing lipohypertrophy
  5.  Insulin infusion technique
  6. Needlestick injuries and sharps disposal

These ‘Golden Rules’ have also been published as a separate booklet and are designed as an easy to read reminder of best practice injection technique to help clinicians care for people with diabetes that use injectable therapies throughout the UK.

Debbie Hicks, FIT UK Board Chair, comments: “For those people with diabetes using injectable therapies, best practice injection technique is a crucial element of condition management as it is essential for therapies to achieve their optimal effect.1 Poor technique can lead to injectable therapies being absorbed in an unpredictable manner,2 and immediate problems such as hypoglycaemia and hyperglycaemia may result.3 In the longer term, poor glycaemic control can increase the risk of complications including kidney failure, blindness and limb amputation.4

“Best practice injection technique has the ability to reduce hypoglycaemic episodes and encourage glycaemic stability,5 and FIT’s overarching mission is tosupport people with diabetes using injectable therapies to achieve the best possible health outcomes that are influenced by correct injection technique. These recommendations are designed to help ensure that the correct prescribed dose of medication is delivered to the correct injection site, using the correct technique, thus helping to avoid diabetes related complications.”

FIT UK’s Recommendations were updated following the Forum for Injection Technique & Therapy Recommendations (FITTER) congress, held in Rome in October 2015. At the event, international FITTER Recommendations were created by a group of 183 diabetes experts from 54 countries, based on findings of the largest ever injection technique survey, which took place from February to June 2015, and involved over 13,200 participants from 42 countries.

Diabetes UK estimates that more than one in sixteen people in the UK have diabetes (diagnosed or undiagnosed) and that there are four million people living with diabetes in the UK, a figure which is projected to rise to five million people by 2025.6

To find out more about FIT UK and to download the latest recommendations please visit

To request a copy of the ‘Golden Rules’ please email [email protected].

To find out more about the international FITTER recommendations please visit


  1. De Coninck C et al. The 2008-2009 Insulin Injection Technique Questionnaire Survey: results and analysis. J Diabetes 2010; 2: 168-179
  2. Hirsch LJ, Gibney MA, Albanese J et al. (2010) Comparative glycemic control, safety and patient ratings for a new 4mm x 32G insulin pen needle in adults with diabetes. Current Medical Research & Opinion, Vol. 26, No. 6, 2010, 1531-1541
  3. Polak M, Beregszaszi M, Belarbi N, et al. (1996) Subcutaneous or intramuscular injections of insulin in children: are we injecting where we think we are? Diabetes Care, 19 (12): 1434-6 and Birkebaek NH, Solvig J, Hansen B, Jorgensen C, Smedegaard J, Christiansen JS. (2008) A 4-mm needle reduces the risk of intramuscular injections without increasing backflow to skin surface in lean diabetic children and adults. Diabetic Care, 31(9): e65
  4. UK Prospective Diabetes Study (UKPDS) Group. (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352:837–853
  5. Forum for Injection Technique (2011), Diabetes Care in the UK: The First UK Injection Technique Recommendations 2nd Edition.
  6. Diabetes facts and stats revised: November 2015, Next Review May 2016 Diabetes UK.

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