You're out in public, surrounded by people without diabetes, and you need insulin. So, instead of pulling up your shirt and showing some skin, you opt to just inject through your clothing.
Gasp... Oh my! What are you thinking?!
The habit of stabbing a syringe through your clothing is a controversial one that's long been debated within the diabetes community.
Curious about the actual safety aspects of this practice, our correspondent Mike Lawson decided to examine the issue and learn what the medical consensus is at this point.
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Injecting insulin through clothing is kind of like driving a few miles over the speed limit. Most of us have done it even though we know it's against the rules.
If you are doing multiple daily injections of insulin to treat diabetes, there is a good chance that you have also injected insulin through an undershirt or tights a couple of times.
A recent survey done in early December on Glu.org, a patient community that's part of the T1D Exchange, shows 54% of respondents (198 people) have taken an injection through clothing. And even those of us here at the 'Mine have done this. Mike Hoskins says that he does it regularly now that he's taking a pump hiatus, especially when he's not in the privacy of his own home. Usually, though, he only stabs himself through a thin layer of clothing and won't inject through heavier clothes like jeans or a sweatshirt.
If so many of us do it with little to no ill effects on our insulin absorption or injection sites, does that mean it's definitely safe?
Opinions from medical professionals differ, with most towing the line and urging people with diabetes (PWDs) not to inject through clothing because of injection risks. But really, there's not much official data on this practice.
Just One Study
The only official study on this practice dates back to 1997, when some researchers at Wayne State University in Detroit did a study on the subject. Published in the American Diabetes Association's journal Diabetes Care, the study involved 50 PWDs, and 41 of those people completed the study, doing a total of 13,720 injections. The data found that injecting through clothing was a "rogue" technique, but concluded that it was indeed "safe and convenient." None of the PWDs experienced problems at the injection sites, and only minor problems like blood stains on clothing and bruising, were recorded in their logbooks. Most of the people reported that injection through clothing offered benefits such as convenience and saving time (no kidding!).
Still, that study was done 15 years ago. And it also came at a time before insulin pumps were as mainstream as they are today, so people weren't doing "multiple daily injections" the way they are today; the practice then was more likely two or three shots a day of an insulin mix.
An ITC (Injecting Through Clothing) Veteran
Fellow PWD Jamie Naessens in Canada agrees with the conclusion of that ADA study. Jamie injected insulin through her clothing for years 18 years before transitioning to an insulin pump.
"Eighteen years is a long time to be doing a certain behavior with no negative outcomes," she said, claiming to have not seen any abnormal scarring or insulin absorption rate from this technique. "Diabetes isn't easy and you take shortcuts sometimes to get through the day."
Even though almost all of her injections were done through pants or shirts, Jamie said that she knew that it was not the "proper" technique. "I was always afraid of my doctors labeling me as a 'bad diabetic,' so I never told them. I figured that what they don't know won't hurt them."
According to Dr. Larry Hirsch, the Vice President of Global Medical Affairs for Diabetes Care Business Unit at BD, the makers of many of the insulin syringes and pen needles used in the U.S., "hurt" is precisely why he thinks that injecting through clothing is a bad idea.
"When you inject this way you are blunting the needle and making it more resistant to glide through your skin and fat," he said. "These needles were designed for injecting through the skin and we believe it's the most appropriate way for them to be used."
Larry isn't isn't just a doctor who works at a needle-making company; he's also been living with type 1 diabetes himself for 55 years, is a Joslin Medalist, and said that he has never injected insulin through his clothing. He says this method could introduce microorganisms under the skin that would cause infection.
"Clothing is not sterile," he said. "But a new needle is always sterile. (BD) makes sure of it."
No Harm Done...?
Larry concedes that there is no study providing evidence of potential problems like infections or increased pain. But he was also critical of the 1997 study from Diabetes Care mentioned above.
"In 1997, needles were larger in diameter than they are today," he said, noting that the study was also done with a modest number of participants and was too short to gauge any long-term effects.
There's no indication anyone in the medical community or diabetes research world is currently studying this issue, but the change in practice since the last time this issue was studied indicates it's probably time for more current data. Until a more thorough study of people injecting through clothing comes out, it's difficult to say that doing so is harmless.
But I guess like occasionally driving too fast, most of us are going to do it from time-to-time when we're in a hurry.