Insulin Injection Technique Recommendations Proper injection technique is essential to effective management of diabetes. According to a survey of more than 13,000 insulin-injecting patients from 423 centers in 42 countries evaluating patient characteristics including historical and practical aspects of their injection technique titled “Worldwide Injection Technique Questionnaire Study” many people who inject themselves with insulin to control diabetes are not doing this in a correct way. Based on the survey results, recommendations on type of needle to be used, to the site of administration etc. have been drawn up for these patients, published online September 1, 2016 in Mayo Clinic Proceedings along with the findings of the survey. • The shortest possible needle length should be used to avoid intramuscular injections which can result in hypoglycemia and glucose variability. Using short needles also causes less lipohypertrophy. • Injection sites should be rotated to prevent lipohypertrophy as lipohypertrophy was associated with higher rates of unexpected hypoglycemia and glycemic variability including more frequent diabetic ketoacidosis. • Thin needles i.e. with higher gauge numbers are recommended. Lipohypertrophy is less frequent with 32-gauge needles and needle reuse is lower with this gauge; correct site rotation is more frequent. • Pen needles and syringes should be used only once. • The recommended injection sites are the abdomen, thigh, arm, and buttock. • The needle should be left under the skin after the plunger has been completely pushed in for 10 seconds or longer before removing it. Patients should be taught to count for 10 seconds after the button has been fully depressed and then remove the needle from the skin.