This study assessed the knowledge and practices of diabetic patients on insulin therapy in Khartoum, Sudan. It surveyed 385 diabetic patients across several hospitals and clinics. The study found that most patients injected insulin into their thighs or arms but that many did not properly change injection sites. It also found that while most knew the symptoms of low blood sugar, many did not correctly understand how to prepare an insulin dose or the proper injection technique. The study recommends better educating patients about disease management, insulin preparation and administration, storage, and expiration dates to improve outcomes.

1. Assessment Of Knowledge And Practice Of
Diabetic Patients Towards Insulin Therapy In
Khartoum State
Presented by:
Afrah Abuagla Awad alkarim Hamd Elnail
Master in Clinical Pharmacy
Lecturer at the Department of pharmacology and Toxicology
Omdurman Islamic University

2. ‫تنزيله‬ ‫محكم‬ ‫في‬ ‫القائل‬ ‫العالمين‬ ‫رب‬ ‫هلل‬ ‫الحمد‬(‫م‬ ً‫ا‬‫احك‬َ‫ض‬ ‫م‬َّ‫س‬َ‫ب‬‫ت‬َ‫ف‬‫ا‬َ‫ه‬ِ‫ل‬‫و‬َ‫ق‬ ‫ن‬
َ‫أ‬ ‫ي‬ِ‫ت‬َّ‫ل‬‫ا‬ َ‫ك‬َ‫ت‬َ‫م‬ْ‫ع‬ِ‫ن‬ َ‫ُر‬‫ك‬ْ‫ش‬َ‫أ‬ ْ‫ن‬َ‫أ‬ ‫ي‬ِ‫ن‬ْ‫ع‬ ِ‫ز‬ ْ‫و‬َ‫أ‬ ِ‫ب‬َ‫ر‬ َ‫ل‬‫ا‬َ‫ق‬َ‫و‬َ‫أ‬َ‫و‬ َّ‫َي‬‫د‬ِ‫ل‬‫ا‬َ‫و‬ ‫ى‬َ‫ل‬َ‫ع‬َ‫و‬ َّ‫ي‬َ‫ل‬َ‫ع‬ َ‫ت‬ْ‫م‬َ‫ع‬ْ‫ن‬‫ن‬
ِ‫ف‬ َ‫ك‬ِ‫ت‬َ‫م‬ْ‫ح‬َ‫ر‬ِ‫ب‬ ِ‫ي‬ِ‫ن‬ْ‫ل‬ ِ‫خ‬ْ‫د‬َ‫أ‬َ‫و‬ ُ‫ه‬‫ا‬َ‫ض‬ْ‫ر‬َ‫ت‬ ً‫ا‬‫ح‬ِ‫ل‬‫ا‬َ‫ص‬ َ‫ل‬َ‫م‬ْ‫ع‬َ‫أ‬َ‫ين‬ ِ‫ح‬ِ‫ل‬‫ا‬َّ‫ص‬‫ال‬ َ‫ِك‬‫د‬‫ا‬َ‫ب‬ِ‫ع‬ ‫ي‬.)

3. Introduction

4. Diabetes mellitus is one of the most prevalent
chronic diseases.
Treatment of diabetes is a lifelong one and is
important in controlling and preventing
complications.

5. Patients treated with insulin, particularly face
many problems like problems of
injectionstechnique , storage of insulin,
preparation of dose …ect.

6. Knowledge about these aspects and about
complications related to insulin or to treatment
in general is essential for any diabetic patient
taking insulin.

7. This study is expected to explore these problems
and to identify gaps in knowledge and practice
that need to be tackled and solved.
Specific answers to these questions are expected
to give key information for health care
planners.

8. The proper way to draw insulin
from the vial

9. The hands should be washed with soap.

11. The top of the vial should be wiped with an
alcohol swab.

13. All insulin preparations, except rapid- and short-acting
insulin and insulin glargine, the vial or pen should be
gently rolled in the palms of the hands (not shaken) to
resuspend the insulin.

15. The insulin vial should be taken and the
equivalent amount of air to the dose should be
drawn to avoid creating a vacuum.

17. For a mixed dose, sufficient air should be put into both
bottles before drawing up the dose.
When mixing rapid- or short-acting insulin with
intermediate- or long-acting insulin; the clear rapid-
or short-acting insulin should be drawn into the
syringe first.

18. The needle should be pushed through the center
of the rubber top of the sterile vial.

20. The air should be pushed into the sterile vial .

22. The vial and syringe should be turned upside
down.

24. The plunger should be pulled down slowly to
get insulin into the syringe.

26.  After the insulin is drawn into the syringe, the fluid
should be inspected for air bubbles.
 Air bubbles themselves are not dangerous but can
cause the injected dose to be decreased.

27. Site of Injection

28. Insulin may be injected into the subcutaneous
tissue of:
 The upper arm.
 The anterior and lateral aspects of the thigh.
 buttocks
 Abdomen (with the exception of a circle with a 2-inch
radius around the navel).
Intramuscular injection is not recommended for
routine injections.

30. The abdomen has the fastest rate of absorption,
followed by the arms, thighs, and buttocks.

31. Areas of lipohypertrophy usually show slower
absorption.

32. Injection technique

33. A fold of skin should be grasped lightly then the
needle inject at a 90⁰ angle.

35. Thin individuals or children should use short needles
or may need to pinch the skin and inject at a 45° angle
to avoid intramuscular injection, especially in the
thigh area.

36. Routine aspiration (drawing back on the injected
syringe to check for blood) is not necessary.
Particularly with the use of insulin pens, the needle
should be embedded within the skin for 5 second after
complete depression of the plunger to ensure complete
delivery of the insulin dose.

37. Rotation of the injection site

38. Rotation of the injection site is important to prevent
lipohypertrophy or lipoatrophy.
Rotating within one area is recommended rather than
rotating to a different area with each injection.
This practice may decrease variability in absorption
from day to day.

40. Storage area

41. The vial in current use can be safely kept at room
temperature in a dark place without losing any
potency, as most patients will consume it within one
month .

42. In rural areas or when refrigerator are not available, it
advisable to put the vial in a plastic bag, tie a rubber
band and kept in wide mouth bottle filled with water.

43. During travel, insulin should be kept in a flask with ice
or in a hand bag or proper container if outside
temperature is less than 30.

44. Expired date

45. Each insulin vial is stamped with an expiration date, a
slight loss of potency may occur after the vial has been
in use for _30 days, especially if stored at room
temperature.

46. If human insulin vials are stored under refrigeration
while in use and are used beyond 30 days, the
stability of these vials may be affected by a
number of factors; such factors include the number
of injections per day, volume of insulin remaining
in the vial, exposure to light, agitation, and
technique used for dose preparation.

47. Objectives:
General objectives:
To assess knowledge and practice of diabetic
patients towards insulin therapy in Khartoum
state.

48. Specific objectives:
1-To assess knowledge of diabetic patients towards
insulin therapy regarding:-
preparation of dose and Mechanism of injecting
insulin.
Site of injection and site change.
 Storage.
Expired date.
Adverse effects.

49. 2-To observe practices of insulin therapy among
diabetic patients regarding; preparation of the
dose, site of injection and mechanism of injecting
insulin.

50. Materials And Methods
 Study design & Study area:
This study is a Descriptive, cross-sectional survey
performed to assess the knowledge and practice of
diabetic patients towards insulin therapy in several
diabetic centers and hospitals in Khartoum state,
Sudan.

51.  Sample size:
The sample size was estimated using the following formula:
Where n = minimum sample size z = 1.96 at 95%
confidence interval obtained from standard statistical table
of normal distribution p = estimated prevalence of non-
adherence to guidelines in a given population (obtained
from literature) q = precision i.e. prevalence of adherence
in a given population (1 – p) d = margin of error (0.05)
minimum sample size was found to be 385.
n= Z² p q /d²

52.  Data collection tool:
The patients were interviewed and data was collected
by self administered, structured questionnaires.

53. Questionnaire consisted of both closed- and open-
ended questions.
In addition to questions on demographic information,
the questionnaire included questions on preparation
of dose ,site of injecting insulin, injecting technique ,
and storage of insulin.

54. Results

55. The injection of insulin at different sites among
the study participants.
SC tissue of
thigh and arm
81%
Abdominal
Wall
19%

56. Patient’s Knowledge and practice towards: Preparation of dose,
Mechanism of injecting insulin, Injection site change.
Injection Site
Change
Preparation of
Dose
Mechanism of
Injecting Insulin
93%
38%
88%
7%
62%
12%
Yes No

57. The awareness of patients towards the insulin side
effects.
Yes No
83%
17%
4%
96%
Hypoglycemic symptoms Lipodystrophy

58. The different storage place of insulin therapy
among the patient.
Refrigerator Freezer Under Zeer Other
78%
7% 3%
12%

59. Patients’ awareness towards the expired date.
Yes
No
51%
49%

60. Conclusion
According to this study it was conclude that the
majority of the study participants injecting insulin in
the subcutaneous tissue of thigh and upper arm.
Most of them changed their injection site .however ,
most the patients had a poor knowledge and practice
towards the proper way to draw insulin.

61. Most of the patients knew the hypoglycemic symptoms
and few of them complaint of lipodystrophy .
This study explored several aspects of insulin therapy
related knowledge and practice of patients and
identified the need for improvement in their practices
for insulin.

62. Recommendations
According to this study, the researcher is willing to
recommend the following:
The patient should be educated about the disease, the
complications and need of insulin in order to reduce the
progression of complications into adverse health
outcomes affecting quality of life .

63. They should be taught and reviewed about the
preparation of dose and the injection technique yearly
and earlier if the local site complications are present.
The insulin vial should be inspected before use.
The proper storage place of insulin should be
explained.

64. World Journal of Pharmaceutical Sciences
ISSN (Print): 2321-3310; ISSN (Online): 2321-3086
Published by Atom and Cell Publishers © All Rights
Reserved
Available online at: http://www.wjpsonline.org/
Original Article

65. Assessment of knowledge and practice of diabetic
patients towards insulin therapy
Afrah A. Awad Elkarim1, Mahmoud M. E. Mudawi2,1, E.
M. A. Elmahdi3, Aimun A. E. Ahmed1
1Department of Pharmacology and Toxicology, Faculty
of Pharmacy, Omdurman Islamic University, Sudan
2Department of Pharmacology and Toxicology, Faculty
of Pharmacy, Northern Border University, KSA
3Department of Internal Medicine, Faculty of Medicine,
University of Khartoum, Sudan

66. The willto win,The desire tosucceed , The urge to reach
your fullpotential,these are the keys that willunlock
the door topersonalexcellence..

67. Have a nice day