There's Always a First Shot

Once upon a time, everyone who uses insulin or other injectable medications had to take their first shot. It's a nerve-wracking experience, to be sure, and one that elicits fear, loathing, sweating, tremors, tears, and memories of childhood injections. Remember when you were a kid, and needed a shot? The needle seemed like a spear, and the syringe must have been big enough to contain five gallons of whatever-it-was that was proposed to be injected. Tears, screams, and the word "no" were an altogether common response to seeing the device of doom. And that fear carries over to most adults, I think.

As a physician dealing with diabetes in my office practice for many years, I've seen adults with diabetes who absolutely refused to inject, even after months of poor control, and much cajoling from nurses and even from their diabetes doc (namely, me). And most people took a while to work up the nerve to "do the thing."

So did I. I recall sitting alone a big room in my house, needle/syringe in hand (and, empty, by the way), my skin scrubbed to a bright pink color, and my face probably turning red. After sweating a while (must have been at least five seconds, but it seemed like five hours), I jabbed myself, and thought the classic thought that everyone verbalizes after the first shot: "That didn't hurt a bit!"

Really, giving oneself an injection is practically painless, what with the new super-small needles, and with the proper technique. Here's some thoughts for anyone who hasn't yet given themselves a shot (and who's read this far in this essay) to make that dread first shot a snap.

I think that any physician who tells the patient to go home and give their first shot at home is guilty of a miss-demean-or: everyone who needs to learn to "shoot up" would benefit from having a coach who's used to teaching correct techniques for self-injecting. And if that coach happens to be the patient's physician, it's way better. In my office practice, I routinely demonstrated my technique on myself with a "dummy" needle/syringe (that is, the needle/syringe was the dummy, not the doctor...).

Here's my advice:

First, skin-cleansing is overrated. For a single dummy shot, I wouldn't bother, unless you've been rolling about in a pigpen beforehand. (Ditto for most injections of real medication, BTW.)

Second, the demo shot should be with an empty needle/syringe unit, with the plunger fully plunged. I'll call this a "N/SU" in the rest of this essay; what you call it is up to you!

Third: Pick up the N/SU, but don't hold it like you'd hold a pen or pencil for writing; rather, grab it in such a way that you make sure you can reach the top of the plunger with your thumb (so you can push the contents of a "real shot" into you).

Fourth: With your other hand, "pinch an inch" -- pick up a chunk of belly flab from your abdominal wall and pinch it so it creates a nice roll between your thumb and other fingers.

Fifth: Starting from an inch or two away from the skin surface, "throw" the needle all the way in, into the center of the roll of flab. Don't stop at the surface. Watch what you are doing so you don't goof and stab the fingers of your other hand!

Sixth: Once the needle is in, release the roll of flab.

Seventh: With the hand that's holding the N/SU, reach up with the thumb and press the plunger to push the medication in (of course, this being a dummy shot, there's nothing to press, but do it anyway.) If it's more convenient to press the plunger with a finger from the other hand, that's fine.

Eighth: Pull the N/SU out, and with your other hand, promptly put a fingertip over the hole. Don't bother rubbing; the only reason to cover the hole is to decrease the potential of a drop of blood leaking out.

Ninth: Say "That didn't hurt a bit!" or whatever choice words immediately come to mind.

But wait, there's more...

Before having the patient start giving the "dummy shot," I'd demonstrate the whole process on myself, explaining each step as I went. Then I'd hand a capped needle/syringe unit to the patient, and tell him to KEEP IT CAPPED, and to demonstrate the process on himself/herself, describing each step as they go. This gave the patient a chance to review the steps, to talk their way through what they were doing (and to correct any mistakes in sequencing the steps), and to build muscle-memory for the actual process of "throwing" the N/SU into the skin. Of course, since the needle was capped, the patient couldn't penetrate the skin, so it was obviously pain-free, and the patient could focus on getting the steps right rather than worrying about the pain factor.

"That didn't hurt a bit!"