Maybe you’ve done this at a movie theater or at a local restaurant. It’s quicker and it’s convenient. You just gave yourself an injection of insulin through your T-shirt. Is that okay? Can I inject insulin through my clothing?
According to a study done in 1996, the American Diabetes Association says that injecting insulin through clothing is safe. However people with diabetes who are immunocompromised, experiencing recurrent or ongoing infection, or have recently endured trauma should not utilize this practice.
Note that this study took place in 1996. Another study took place in 1997. Each of these studies had less than 50 participants, and both studies were carried out for only 20 weeks.
Since no significant side effects were documented, the results in both studies concluded that injecting insulin through clothing is considered safe.
Safety of injecting insulin through clothing
While researching information on this topic, I found valid and credible information from the 1990’s. The most current information is from 2006. This information is out of date,
Over the years, more attention is given to the issue of contamination. Rules and regulations have become more strict with the increased knowledge regarding contaminates and potentially harmful bacteria and such.
Improvement with insulin supplies over time also plays a role. In the 1990’s, needles were longer and thicker, which would have made it easier to inject through certain materials.
Newest Thin Insulin Needles
Insulin pen needles today are much smaller, both length and gauge (thickness).
The smallest needle, the nano BD Nano needle, was first introduced in the United States in 2010. This 4 mm, 32 gauge needle has technology that promotes comfort and is easier to use. This needle is about as thin as two strands of hair.
The second generation BD Nano needle was brought to market in January 2019. This design provides a more reliable injection depth, which reduces the risk of intramuscular injections.
Injecting Insulin Through Clothing Case Study
Documented in practical diabetes international on April 10, 2006, is a case study of a 40-year-old female with type 1 diabetes. She developed abscesses in both thighs when she was injecting her insulin through her clothes. https://onlinelibrary.wiley.com/doi/full/10.1002/pdi.896
At the time this document was created, she had had 18 operations for drainage of abscesses and debridement. It cannot be completely proven that injecting insulin through clothing was responsible for this patient outcome, but this experience prompted her surgeon from Sandwell General Hospital in Birmingham to heed caution if using this practice.
Who Should Take Extra Precaution When Injecting Through Clothing:
- People who are immunocompromised (cancer, HIV/AIDS, post organ transplant)
- Individuals with active or recurring infections
- People with recent trauma, recent surgery, healing needs
Dangers of Injecting Insulin Through Clothing:
- Needle not injecting into skin properly, causing injury
- Dirty needle
- Dirty or contaminated clothing
- Fibers contaminating the injection site
- Risk of bending your needle
- Possibility of not injecting the proper amount of insulin
- Risk of your pen jamming up (see my article on how to fix a jammed insulin pen)
IDC Recommendations on Injecting Through Clothing
After speaking with a nurse who works with endocrinologists from the International Diabetes Center (IDC) headquarters in Minneapolis Minnesota, I gained additional data. She and her colleagues work directly with patients who have diabetes.
She tells me that the providers and medical staff at this institution do not promote or recommend injecting insulin through clothing, as it is not sterile.
Diabetes Education Specialists Forum Commentary
In my international group of Diabetes Care and Education Specialists, I brought this subject to attention. We are diabetes education specialists from all over the country, and we bounce questions and new information off of each other.
While compiling data for this article, I posted the following question to the forum:
“I am writing an article about injecting insulin through clothing. What are your thoughts on this practice? I have always discouraged it for contamination purposes, among other reasons. I am having trouble finding any current research. Do any of you have any feedback?”
These were my responses:
Joan H. – “I’d be interested in any studies! I know many of my friends tell me they do it!! Let us know if you find out any science!”
Theresa D. – “I advise against it, especially if using nano pen needles.”
Jennifer Y. – “Never heard of it!”
Amy N. – “Yikes. I would give that a no, no, and no! Broken needles, unclean skin, and possibly unclean clothing.”
Eileen A. – “The pen needles are too flimsy. I would not recommend it!“
Karen B. – “Interesting. “
Jennifer F. – “I have never even heard of that. Would be interested to hear your findings. It doesn’t seem like a good idea though!”
Emily A. – “My patients tell me this is cleaner than a bathroom, but I teach against dulling and breaking the needle, contamination, and general hygiene.”
Nancy H. – “I am familiar with this question and have seen recommendations from endocrinologists that it is OK to do it! The most important step for using alcohol was drawing up insulin from the bottle. In 30 years, no problems with infection.”
- I would like to address Nancy’s comment. She alludes to using alcohol when “drawing insulin up from the bottle.” If someone is drawing insulin up from a bottle, that tells me that they are using a vial and syringe. The needles on the vials are thicker and longer, which would make it easier to inject your needle through clothing.
Comments From Colleagues
When I offered the question to my colleagues and coworkers, most have them have not encountered it. Educators and endocrinologists in my region do not teach, encourage, or condone injecting insulin through clothing.
One of my colleagues, Stacy C., from Community Memorial Hospital in Cloquet Minnesota tells me that when she worked for Hennepin Healthcare in Minneapolis, MN, 20 or more years ago, she knew of several young people with type 1 diabetes who would inject through their clothing because they had to do so many injections per day, and they lead busy lifestyles.
Stacy says that the topic does not come up in her practice today because the medical providers and diabetes education specialists do not endorse this practice.
Diabetes Education Specialist Experiences
Only two times in my career have I witnessed someone with diabetes injecting insulin through their clothes. One middle-aged gentleman injected his thigh through his jeans, and an older female did the same through her shirt. Both of these occurrences took place during a counseling session in my office.
No one wants to excuse his or herself from a show or from the bar at a crowded restaurant to go to the restroom to inject their insulin. Interrupting your circle of friends, excusing yourself through crowds to get to the restroom, and possibly waiting for a private moment to take your medication is a complete inconvenience.
When teaching people how to do their own injections, I demonstrate the steps with a sample insulin pen and a padded cushion that resembles an area of fake skin. I utilized proper practice by sanitizing my skin model and proceeding with proper technique.
I then asked my clients to repeat the procedure in front of me to make sure they are comfortable with the procedure. Sometimes when I have had clients just starting their long acting insulin, I have them do their first injection in front of me.
I show people the different places they can inject and encourage them to rotate their injection sites to avoid insulin induced lipodystrophy. I make sure that everyone understands the demonstration and that they utilize the hygienic procedures when doing their insulin at home.
However, I see many patients and clients that have had diabetes for years, and have received information and education from different educators in different areas. They may have adopted different practices.
Having worked in nursing homes, a rehab center, clinics, and a trauma center where contamination is a concern. In my 20 plus year career, I have never promoted this practice, and never worked with a doctor or endocrinologist that did.
If you are someone who injects insulin through your clothing, I would recommend talking to your doctor or your diabetes education specialist. This is not something that I would condone.
As you can see from my research, my experience, and my input from fellow experts and colleagues, the practice of injecting insulin through your clothing is discouraged by most.
If injecting insulin through your clothing is something you were considering, I recommend speaking with your doctor or diabetes education specialist first.
If this is something that you have been doing it for quite some time, I encourage you to give it a second thought about continuing. Talk to your doctor and diabetes education specialist to verify the safety of your procedure.