**13. Safety**

Patients should never share insulin pens, whether in the hospital or at home setting. Blood can be aspirated back into the pen cartridge even after one injection, and this could possibly transmit a blood-borne disease such as HIV or hepatitis to the next user. Sonoki [88] found hemoglobin in a number of cartridges which patients had used only once. Le Floch [89] also studied the contamination of cartridges after one use and found similar findings. A recent US study corroborated these findings [90]. The rule with insulin injections is clear: one patient/ one insulin pen.

Insulin needles are the most commonly used sharp worldwide. If not disposed of properly, needle-stick injuries with used insulin needles could transmit hepatitis, HIV, or other bloodborne pathogens. This is a major public health issue. Technologies exist to minimize this risk. FITTER recommended the following to minimize the risk of needle-stick injuries, particularly in a hospital or other inpatient setting:

• Safety-engineered devices play a critical role in protecting injectors, pump users, and downstream workers [91]. **A1**

patients and professionals may not have previously considered: the choice of injection sites as a function of the insulin delivered, the choice of needle length as a function of SC thickness, the injection or infusion technique which ensure consistently effective SC delivery, the precise and systematic rotation of delivery sites, reduced or non-reuse of sharps, and safe disposal of used sharps which reduces needle-stick injury risk to family members or the community at large [96]. We have provided both evidence-based recommendations and proof that these work in practice and deliver insulin with an improved therapeutic index and better outcomes—both clinical- and patient-reported. The challenge now is to scale these recommendations so that all insulin-using patients and insulin-prescribing professional know and

Optimal Insulin Delivery

67

http://dx.doi.org/10.5772/intechopen.76232

Authors KS and LH are employees of BD, a manufacturer of injecting devices. All other

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a

FITTER Forum for Injection Technique and Therapy: Expert Recommendations

follow them.

**Authorship**

**Abbreviations**

BMI body mass index

DKA diabetic ketoacidosis

G gauge (of needle).

GCP good clinical practice.

FIT Forum for Injection Technique

**Conflict of interest**

authors declare that they have no conflict of interest.

whole, and have given final approval to the version to be published.

CSII continuous subcutaneous insulin infusion

GLP-1 glucagon-like peptide-1 receptor agonists

