Self-injecting - another perspective

[helvella]

Someone I know recently returned home from a distant hospital where he had been receiving chemotherapy.

He was told by the hospital that he needed an injection, in the stomach, every day. First option was for him to do it himself.

In both his and my views, there is no way he could manage at present. He has never injected anyone. His mental state is, shall we say challenging, due to the illness and the treatment. (Poor chap is suffering a lot.)

He had to get in touch with local services and they have arranged for a district nurse (or whatever) to come and do the injections.

My point is simple. How come we see the extreme split between GPs throwing their hands up in horror at PA patients who ask to be allowed to inject themselves. And a hospital pretty much assuming that an injection naïve patient would be able to inject himself with no, or very little, training.

Despite the savings in costs to the GP surgery. The increase in convenience to the patient. And, on the other side, the real concern and outright fear of this person.

[deniseinmilden]

It beggars belief, doesn't it!

It's OK to self inject hormones for fertility treatment which arguably has the potential to be detrimental to health, but not life-saving B12.

There are a number of other things where SI is encouraged too, and in some cases, eg methotrexate, the drug is one that is carefully controlled because of its potential danger, unlike B12 which is arguably safer than water!

Mad!

Thank you for bringing this up.

[helvella in reply to deniseinmilden]

I think it was the combination of it being suddenly sprung upon him, and him being in a state in which he is often unsure whether he has taken the right tablets, that really got me.

[deniseinmilden in reply to helvella]

It's just so wrong on so many counts, isn't it!

(I'm not sure I was much better when I started doing my jabs - could barely walk or talk and smashed my first ampoule with my fingers because I had so little feeling - but at least I improved with them!).

[FlipperTD in reply to deniseinmilden]

It gets madder the more I think about it.

A late friend was on Chemo and needed regular B12 injections. He hated them. He had no known difficulty in absorbing oral B12, and when he presented the oncologist with evidence of oral vs injected B12 therapy, the daily 1mg oral B12 regime was adopted. It made him more comfortable, if nothing else!

[deniseinmilden in reply to FlipperTD]

Wow!!! xx

[wedgewood]

Yes, what could possibly be the explanation for this ? It is not logical . Could some doctor out there ( there must be one on this forum ) explain to us the reason ( unreason !) He/she could be open and honest: without fear of being exposed . I await an explanation !

[Hidden in reply to wedgewood]

Sorry wedgewood I think you might be waiting sometime for a doctor brave enough to openly admit on any forum or media that there are double standards as to injecting.Right for insulin, warfarin etc, but b12 No No.

But it is a strange world we live in.

[jaybirdxNHM in reply to Hidden]

I was watched once by nurse at GPs doing IM jab ,took 3 mins. So now I do them every 2nd/ 3rd day . G P agreed to save them money. They would not do more often than _2mthly. He said they never do SQ. No help with my very dodgy fingers ,but a snapper solved that . The info on here made life so much easier. Thanks everyone.

[Nackapan in reply to jaybirdxNHM]

I was told by the nurses they are not licensed to deliver b12 sc.So eoukd not show me.

Wouldn't allow IM at home as no one available to teach me.

( I wasn't keen either)

It wax a neurologist that condoned my suggestion of sc at home.

That was skso ignored.

Bought done b12 and neefkes ect with help from here.

Then a Gp rang.

She decided coukd have b12 on prescription sbd do sc at home.

Stating I had to take full responsibility. Sgexsaid had to ho against her peers in the practice

'Off licence '

Many things are in practice.

I find no difference in effect.

Still have IM at the surgery.

Really to have a note made on my notes ab yo stay visible.

Saved the NHS money on nurses time and for a year paying the prescription charge . Another oddity as no charge done st the surgery.

B12 has not been on the agenda for way too long.

Preventative work!!

On the blood form.

[JGBH in reply to wedgewood]

Like you I would like to hear an honest open reason from any GP who is not behaving with the usual double standards and hypocrisy! It’s amazing how they can totally turn things around to suit themselves. I too self inject B12, it is safe, and a biologic to control RA, Tocilizumab, this has to be monitored regularly. I fear we could wait for ever for any honest answer because we know this will not happen….

[topazrat]

I can remember when my daughter was diagnosed with diabetes. She stayed overnight in hospital and was sent home the next day with neither I, nor her, having done an insulin injection. She couldn't inject herself at that point, so it was up to me to jab her following her instructions that had been given to her by a nurse the day before! Very far from ideal. And yet if I asked my G.P. if I could inject my own B12, the answer is no, because you don't know what you are doing. It just doesn't make sense.

[JGBH in reply to topazrat]

When I first got B12 injections (after a very long and hard fight with the GP and advice from a wonderful member of the PA forum as well as from PAS in Wales) this was done by a nurse at the surgery. One day, my GP said to me this was costing them a lot…. (sigh! ) so I suggested I would like to be taught how to do the injections by a nurse if she would agree to it, it was the logical route to go. She agreed, after few weeks I was able to do the injections myself. It’s pretty hard at times because I have RA and my finger joints are very painful and can’t always function as they should…. Plus it’s rather hard to break the neck of the ampoules quite often because of RA… Once I had to phone a neighbour asking him to come over to do so…. So may I suggest you ask your uncooperative GP to organise for a nurse to “teach “ you how to do the injections? It’s pretty easy once you know where to inject? Good luck.

[Gambit62 Administrator]

The main justification for opposition to self injection is the assumption that B12 injections need to be IM - and I'm not aware of an instance in which patients have been sent home with injections that are done IM - it is always injections that are SQ.I am not sure where the opposition to doing B12 injections SQ comes from but it may be down to the fact that there have been some issues with necrosis as a result of SQ injections, though this has only been reported in cases where the injection was suspended in oil, whilst the B12 used by the NHS is always suspended in saline.

[JGBH in reply to Gambit62]

Thank you for the useful clarification regarding the saline solution.

[helvella in reply to Gambit62]

Which all sounds a bit un-thought through.

Plenty of case reports of subcutaneous injections causing necrosis. (I do not know what the person I know is getting injected.)

The answer would appear to be ensuring the person understands the possibility, how to identify necrosis (or any other significant issue), and what to do about it. Most especially the regular injectors are the ones who can be well educated. Getting asked to do it every day when already very ill doesn't seem sensible at all.

[Gambit62 Administrator in reply to helvella]

I agree but it is pretty standard practice - as is sending patients home with high doses of painkillers such as tramadol - things often aren't entirely thought through.

[helvella in reply to Gambit62]

As someone who took Tramadol for quite a while, I found it fantastic.

And when the underlying issue slowly resolved, I stopped the Tramadol easily and without issue.

I am well aware that this is not the story everyone can report.

[JGBH in reply to helvella]

I was not warned by neither GP nor nurse about possibility of necrosis. I read about it though but agree patients should be made aware.

[Gambit62 Administrator in reply to JGBH]

JGBH, just fpr clarity - going to repeat that I have only come across cases in literature where an oil based injection was being used - it hasn't been reported with saline based solutions of B12

[helvella in reply to Gambit62]

But it has been reported for subcutaneous injections of other substances such as heparin, insulin and interferon.

[Ctadds1 in reply to helvella]

I have never heard of this. My husband gives me my injections in my upper arms but neither of us have been trained how to do so properly. Any suggestions on how to do this properly so to not do any unnessasry damage to my flesh.

[helvella in reply to Ctadds1]

I hope someone who does inject will reply - I don't.

[JGBH in reply to Gambit62]

Thank you.

[Nackapan in reply to helvella]

No it sounds all too much to expect. A blister pack may be useful gir drugs.

The Gp has to sanction it abd the pharmacy maje them up.

My 91 yesr old mum has tgrn.

Has pills put needed on a blister sheet gir each day.

Am

Pm

She finds thus much better.

She is definitely kept more well snd nit worrying what she needs to take when.

[lynxis in reply to Gambit62]

In the US, patients are sent home with IM testosterone injections.

[Nackapan in reply to lynxis]

They are here too in the UK Many injections are sent hone when you leave hospital to Inject.

I thinks it b1e on thr back burner as usual do outdated policies

I seem to remember reading that initially they were given sc??

Might be about the volume of fluid as less given by this route

[Nackapan in reply to Gambit62]

I think it's just the policy has not been looked at .

[earthnymph]

You raise an interesting and valid point. I have friends, a couple, with learning disabilities and severe and enduring mental illness. After the birth of their child they were sent home with injections to do themselves (I don’t know if IM or SC), without having been shown how, and with written instructions they couldn’t follow. Sadly that wasn’t the only inequitable treatment they experienced. They are all fine and well now. I am trained in venepuncture, have si insulin for 8 years (off it now) but my go surgery refuse to show me IM SI for my b12. They are aware I’ve been doing it for approx 6 years. Hmmm.

[Nackapan in reply to earthnymph]

Yes my friends daughter had sc injections yo take hone after having s bsby

[FlipperTD]

Scientist, not medic, and a purely personal viewpoint.

I spent much of my career using needles on others, doing the occasional phlebotomy, typically on 'difficult patients' and 'difficult veins'. For over 40 years; I must have done thousands.

In January this year, I broke my left ankle quite badly, [not as if there's a good way to do it] and one of the delights I endured was a daily SC Tinzaparin injection, self-administered, to reduce the risk of DVTs. The 'training' was not even the traditional 'see one, do one, train one'; it was a case of 'here's how it's done, here's a sharps bin, and here are some boxes of pre-loaded syringes'. The whole process took less than two minutes including the training, and I have survived so far, and I'm pleased it's history. This is admittedly far simpler than IM, but I do wonder why any part of the NHS should have a problem with self-injection, given we support 'needle exchange' and such. I must just be getting old...

Oh, now I think about it, no-one mentioned the [very small] risk of Heparin-induced thrombocytopenia either!

[helvella in reply to FlipperTD]

Typical scientist.

Doesn't take people's word for it but goes off to do an experiment.

[Nackapan in reply to FlipperTD]

May be the volumn of fluid. Some b12 in 2mks?

Or simply outdated policies

[Rikm]

My late wife was expected to do this at the beginning of lockdown last year…..at the same time my B12 injections were withdrawn and I was left in limbo.I then had to go down the Si route, thank goodness I found this forum.

Thank you to everyone who contributes.

[Nackapan in reply to Rikm]

My sympathy goes out to you.Glad you self injecting okay.