study on the practice and safety of injecting insulin through clothes among people with diabetes in Bahrain.

Injecting insulin through clothing: safe or not safe?

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Tenderich (2013) considers injecting insulin through clothing very controversial. Despite the controversies surrounding this exercise it is common to meet patients who practice it. Recent surveys reveal that over 50% of patients have at one point or the other taken an injection through clothing especially when they are in environments that deny them the much-needed privacy (Tenderich, 2013). This research topic is appropriate as there is very little research about the effects of injecting through clothing to people with diabetes with the only official study dating back to 1997. The rise in the prevalence rate of diabetes mellitus that is expected to hit over 640 million people in 2040 necessitates the need to study and understand all the critical issues that relate to the injection of insulin (Husain, Majeda, Ebtihal, & Basma, 2017). Top on the list is the issue injecting insulin through the clothes and its safety. The existing information cannot be generalized as the number of respondents was very low when compared to the percentage of the actual population that is suffering from diabetes mellitus.

Research Question

Is it safe for people with diabetes (P) to inject insulin through clothes (I) or should they inject insulin directly through the skin (C) to realize the desired results (O)? This research, therefore, seeks to understand how safe the practice of injecting insulin is to patients regardless of their gender or race. Injecting insulin through clothes is considered controversial by researchers who believe that it may cause more problems to the patient in question. According to Tenderich (2013) clothes are never sterilized and as such create unsanitary conditions for the injection of insulin. The size of the needles used to inject insulin into the body has also significantly reduced in size making it impossible for it to reach the subcutaneous layer if the injection is done through clothes thus creating room for intradermal complications.

The research review made use of Medline, EMBASE and PubMed databases. Two articles were selected from the search the result of which was five published articles. The keywords used in the search were insulin injection through clothes with the inclusion criteria being limited scholarly articles and other meaningful publications. The articles included were those that looked at the safety of insulin injection through clothes for all patients regardless of their gender or race. The research was further limited to the last five years. Very little information is available concerning the effect that injecting insulin through clothes has on people with diabetes.

Some of the unnecessary words that I excluded were those that relate to children among the infants and pediatric patients. This was because children suffering from this condition cannot inject themselves with insulin. The relevant articles were those that were centered on people who can inject themselves with insulin through clothes a group that excludes babies. Including children, infants or pediatric would have resulted in many articles that would be of little to no use in the current study. By including only those articles that offer meaningful information to the current research significant conclusions are likely to be drawn by the researcher.


Husain et al. (2017) conducted a study on the practice and safety of injecting insulin through clothes among people with diabetes in Bahrain. They used a cross-sectional study that made use of self-administered questionnaires to 100 diabetic patients with the intention of understanding the specific factors that contribute to the injection of insulin through clothes and the associated complications. From the findings of this study, only 30% of the participants had engaged in the practice of injecting insulin through clothing. Embarrassment and emergencies especially at the workplace pushed the patients into the practice. The complications that were experienced occurred at the site of injection; the patients also experienced injecting technique problems, and glycemic control. The researchers took into consideration all the ethical aspects of research to ensure that information relating to those who took part in the study was kept confidential. The limitation of this study was in the small population that was studied.

Frid et al. (2016) studied population parameters and injection practices among 13,289 people with diabetes from 423 centers from 42 countries. Their primary goal was to understand patient characteristics in addition to the historical and practical features of the various injection techniques used. Among the many parameters that were studied was the aspect of injecting insulin through clothing. Only 8% of the studied population injected insulin through clothing. The studied population had an almost equal number of males and females. Those selected for the study were people suffering from diabetes mellitus and who had been on insulin injection for six months. The survey was conducted between February 2014 and end of June 2015.

In the New Insulin Delivery Recommendations by Frid et al. (2016b) what stands out is the fact that very few guidelines are in place to help professionals and patients appropriately manage the condition. An international survey of practices that led to the recommendations was done by about 200 diabetes experts from over 50 countries globally. According to the experts, proper delivery of insulin is necessary to help achieve the targets as far as the control of diabetes is concerned (Frid et al., 2016b). All publications relating to insulin injection that was done between 2008 and 2015 were taken into consideration, and the recommendations are therefore informed by the over 260 articles. The proposals were categorized into three classes A, B, and C. A represented strongly recommended, B being recommended and C being unresolved issues. Injecting insulin through clothes does not comply with the recommendation that injections be done in clean sites after a careful inspection.

Studies on the safety of injecting insulin through clothes reveal that very few patients with diabetes inject insulin through clothes. Patients who engage in this practice were forced to do so due to the absence of privacy, especially at the workplace. Some did it out of embarrassment while other did it out of convenience. Those who practice injection through clothes suffer minor injuries explaining why this controversial aspect of managing diabetes mellitus is still practiced to date. I firmly believe that insulin injection through clothes should be avoided by diabetic patients at all costs. Patients who engage in this exercise may be exposed to the risk of intradermal injection. Clothes are also not sterilized and as such may cause the patients more problems rather than solutions. Clothes also remove the moisture that is meant to help reduce the amount of pain during injection. The studies should have focused purely on the effect that injecting through the clothes has on patients other than focusing on other elements.


The findings of early researchers are opposed to the practice of injecting insulin through clothes. Patients should not resort to this method of managing diabetes but should instead ensure that the injection is done directly to the skin. There is little information that is available to help patients who inject through clothes to embrace the best option of direct injection to the skin. The findings will be incorporated into my nursing practice as I will discourage patients from engaging in the controversial practice of injecting insulin through the skin. I will help them understand some of the injuries they are likely to suffer as a result of using shortcuts in injecting insulin.

The research processes in the area of insulin injection should also be improved by adding more exceptional details to the process to ensure that more convincing information is obtained. The number of participants should also be increased to make the findings more representative of the actual population of people with diabetes. Researchers should also collaborate in this area to ensure that resources are shared to help study a wider area. Researchers in the less studied regions must also play a role in ensuring that existing trends concerning insulin injection in their neighborhoods are documented. Issues relating to insulin injection through the skin and their effects both in the short- and long-term periods must be studied sooner rather than later. This will help patients understand why they should stick to the traditional approaches of injecting insulin.


Husain T., Majeda M., Ebtihal Al Y., and Basma Al S. (2017). The Practice and Safety of Injecting Insulin through Clothes among Patients with Diabetes in Bahrain. Clin. Invest. (Lond.), 7(1), 7-10.

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