Researchers from the University of Florida at Gainsville have developed alternative visual aides to help children find the correct insulin injection sites. The report, published in the April 1996 issue of Clinical Pediatrics, found that children ages 6-11 were significantly more successful at finding injection sites when using "injection bears" than when using the traditional injection charts. The injection bears simplify the process of site recognition by marking teddy bears with injection sites that correspond to the same sites on a child's body.

People with type I diabetes need to rotate their insulin injection sites to prevent lipohypertrophy. Lipohypertrophy is a condition in which fatty cells build up around overused injection sites. It has been linked to erratic insulin absorption and causes metabolic instability. The condition may become a self perpetuating problem because an affected area may lose some feeling, and as a result, children may use the site over and over again.

Denise Richards, a diabetes educator at the New England Diabetes and Endocrinology Center, recommends morning injections in the stomach for quick absorption, mid-day injections in the arm for convenience, evening injections in the buttocks, and bedtime injections in the legs for slower absorption.

Currently people with type I diabetes, regardless of their age, are given maps of the human body to find the correct injection sites. These maps are superimposed with numbered grids and variously shaded areas that tell the patient when and where they should inject his/her insulin. The study showed that this system was too complex for children to follow with a reasonable degree of accuracy.

The study tested whether or not a simpler and more accessible "injection bear" system would increase children's success with this very important aspect of diabetes management.

The study describes a simpler system using "...a pair of teddy bears with simplified numbered grids similar to the injection site chart (glued) over their bodies. Instead of containing a shaded grid to distinguish between AM/PM sites a dark bear is used for PM injections and a light-colored bear is used as a guide for AM injections." To locate an injection site the child puts the back of the teddy bear against his stomach, finds the correct site, according to the date, and then finds the corresponding site on his/her own body.

Richards says the injection bears should be used with adult supervision to get parents and children working together.

The children tested were significantly more successful locating the proper injection sites with the bears and stated a marked preference for the bears over the charts.

The importance of children being able to find the correct injection site is illustrated by the study finding that 39 percent of the subjects had been diagnosed with lipohypertrophy in the past. Only 22 percent of those children who were reported as giving themselves injections with little or no adult supervision used any type of structured method for choosing injection sites. Fewer than half of the families even recalled their doctor giving them a site identification chart, and of those, 81percent reported that they rarely if ever used the charts.