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Ever since Semmelweis, Lister, and Pasteur, doctors and nurses have been taught to follow sterile antiseptic technique, especially where a medical procedure (such as an injection) breaks the skin. Thus those diabetics who must daily inject insulin have been taught to remove clothing, alcohol-swab the injection site, and otherwise preserve maximum cleanliness. But some authorities state such precautions are unnecessary. How clean is clean enough? There has been much argument.

The American Diabetes Association's professional journal Diabetes Care (Vol. 20, No. 3, March 1997) published the results of a study by Doris Fleming, MSN, RN, CS, CDE; James Fitzgerald, Ph.D.; George Grunberger, M.D.; Scott Jacober, DO, CDE; and Melissa Vandenburg, BSN, RN, CDE, in which 50 insulin-using diabetics performed injections both by traditional antiseptic techniques and through a single layer of clothing. Was there any significant difference, either in diabetes control, or in side effects such as nuisance infections?

The researchers were thorough. All participants had a skin assessment, A1C, and leucocyte count before the test, at the 10-week point (halfway), and again at completion. Problems, benefits, type of clothing (from nylon to denim) and other comments were recorded by the subjects in an "injection log."

Over the 20-week period, approximately 13,720 injections were performed by the participants. None of the subjects experienced erythema, induration, or abscess at injection sites. Neither the glycosylated hemoglobin levels nor the leucocyte count differed between the conventional or the experimental (through clothing) injection regimens. During the injection-through-clothing phase of the study, participants' logbooks recorded only minor problems, such as small bloodstains or bruising. Subjects reported that insulin injection through clothing offered benefits such as convenience and saving time.

The researchers' conclusion: "It is safe and convenient to inject insulin through clothing."

From the Voice Editor: I have made many injections through my clothing, without problems. However, I would recommend you do this only if you and your clothes are clean. I note that if you are on immunosuppressive therapy (or otherwise immune-compromised), you might need to be more cautious of infection, and avoid this practice. Also, needles, in the name of pain reduction, are getting ever smaller and more fragile, and some of the smallest/shortest may be inappropriate for such use. I saw the above study was also noted in New England Journal of Medicine's newsletter HEALTHNEWS (March 1997).