Insulin Absorption Rates

Table 1factors Affecting Insulin Absorption ( [ 33 ] [ 34 ] [ 35 ] )

Factor Comment Exercise of injected area Strenuous exercise of a limb within 1 hour of injection will speed insulin absorption. Clinically significant for regular insulin analogs Local massage Vigorously rubbing or massaging the injection site will speed absorption. Temperature Heat can increase absorption rate, including use of a sauna, shower, or hot bath soon after injection. Cold has the opposite effect. Site of injection Insulin is absorbed faster from the abdomen. Less clinically relevant with rapid-acting insulins, insulin glargine and insulin detemir. Lipohypertrophy Injection into hypertrophied areas delays insulin absorption. Jet injectors Increase absorption rate. Insulin mixtures Absorption rates are unpredictable when suspension insulins are not mixed adequately (i.e., they need to be resuspended). Insulin dose Larger doses delay insulin action and prolong duration. Physical status (soluble vs. suspension) Suspension insulins must be sufficiently resuspended prior to injection to reduce variability. Continue reading >>

What Affects Insulin Absorption

Of all the factors that seem to impact our blood glucose on a daily basis, insulin absorption rates can be one of the trickiest to manage. Most of us know that insulin is absorbed at different rates depending on where it is injected (or where the infusion set is placed if you’re pumping). The stomach is generally the area that provides the fastest absorption, followed by the upper arms, thighs, and upper buttocks. This is general knowledge for most of us, and if the list were really that simple, it would be fairly straightforward. But this is diabetes — it’s never straightforward!! There are a host of other factors that affect how quickly insulin is absorbed into our system, and many of them can be almost impossible to detect (but some planning and educated guessing can help). Nevertheless, we’ve got to make our best effort to take these factors into consideration when we manage our blood glucose, because the effects of absorption are very real, and can lead to maddening high or low blood glucose readings that seem to “come out of nowhere.” Let’s start by listing what exactly impacts absorption: 1. Site selection. As noted above, the abdomen is generally the “fastest” site for insulin to absorb, followed by the backs of the upper arms, outer sides of the thighs, and the upper buttocks or hips. 2. Subcutaneous tissue (connective tissue and fat) versus muscle. Insulin should be injected into the subcutaneous tissue layer just under the skin. Our insulin needles are designed to inject insulin into this layer. If insulin is injected into muscle, it will absorb significantly faster. This is why some of us pinch up our skin when we inject — it helps ensure that we’re not injecting into muscle, but into the fatty layer we’re supposed to inject into. 3. Continue reading >>

Best Insulin Injection Sites: Absorption Time And Rotation

Insulin is a hormone that helps manage diabetes when it is injected into the body. It can't be taken as a pill or oral medication. This is because the enzymes in the stomach will break down the insulin before it reaches the bloodstream. Insulin injections are one of many ways to treat and manage diabetes. Others include dietary and lifestyle changes, and oral medications. For people who require insulin injections, there are different types of insulin available. It is important to understand and follow the instructions that the doctor provides about how and where to inject insulin. Common injection sites Insulin is injected into the layer of fat directly under this skin, known as subcutaneous tissue. It is injected with a small needle or a device that looks like a pen. There are several different sites where insulin can be injected, including: Abdomen The abdomen is a common site for insulin injection that many people with diabetes choose to use. To give an injection into the abdomen, take a pinch of the fatty tissue from either side between the waist and the hipbones. It should be about 2 inches away from the belly button. This site is easy to access and some people report that it causes less discomfort than other sites. Upper Arms The upper arm is another site where insulin injections can be given. The needle should be placed into the back of the arm (tricep area), about halfway between the elbow and the shoulder. The main disadvantage of this site is that it is very difficult to use for self-administration and may require somebody else to do it. It may be more comfortable to inject into the non-dominant arm. This means injecting into the left arm of a right-handed person or the right arm of a left-handed person. Thighs The thigh is also a very easy area for self-injec Continue reading >>

Consistent Insulin Absorption And Action With No Pronounced Peak1,2

A single-center, parallel-group, double-blind study compared within-subject variability of glucose-lowering effect of Levemir® with insulin glargine U-100 and NPH insulin. Patients with type 1 diabetes received 4 subcutaneous doses of 0.4 units/kg of Levemir® (n=18), insulin glargine U-100 (n=16), or NPH insulin (n=17) on 4 identical nonconsecutive study days. Study followed glucose clamp conditions. Graph represents time-action profiles of 3 individuals.2 Adapted from Heise et al, 2004.2 Continue reading >>

Absorption Rates

1 IM injection of all human insulin should be avoided since rapid absorption and serious hypoglycaemia can result. ( 95,96) 2 The thigh and buttocks are the preferred injection sites when using NPH (intermediate acting) as the basal insulin, since absorption is slowest from these sites. (43,97 3 The abdomen is the preferred site for soluble human insulin, since absorption is fastest there. (16,44,46,98-100) 4 The absorption of soluble (short acting) human insulin in the elderly can be slow and this insulin should not be used when a rapid effect is needed. (14,101) (Note: Insulin actions may overlap) 5 For those people who require very large doses of insulin U-500 insulin maybe an option instead of U-100. U-500 is only available as soluble insulin. However it has a pharmacokinetic profile more closely simulating NPH human intermediary insulin than soluble short acting human. U-100. (5,6,158) 6 Massaging the site before or after injection may speed up absorption and is not generally recommended. (5,6,70) 1 Premixed insulin (human or analogue) should be given in the abdomen in the morning to increase the speed of absorption of the short-acting insulin in order to cover post-breakfast glycaemic excursions. (12) 2 Premixed insulin should be given in the thigh or buttock before evening meal as this leads to slower absorption and decreases the risk of nocturnal hypoglycaemia. (93,97) 3 Massaging the site before or after injection may speed up absorption and is not generally recommended. (5,6,70) 1 Rapid-acting insulin analogues may be given at any of the injection sites, as absorption rates do not appear to be site-specific. (81-85) 2 Rapid-acting analogues should not be given intramuscularly (IM). (82,83,86) 3 Long-acting insulin analogues may be given at any of the injection Continue reading >>

Diffusion And Polymerization Determines The Insulin Absorption From Subcutaneous Tissue In Diabetic Patients

Hildebrandt P, Sejrsen P, Nielsen SL, Birch K, Sestoft L. Diffusion and polymerization determines the insulin absorption from subcutaneous tissue in diabetic patients. Scand J Clin Lab Invest 1985; 45: 685–690. In 23 diabetic patients, the disappearance from subcutaneous tissue of 125I-labelled short-acting insulin and of 133Xe (measuring subcutaneous blood flow (SBF)) were registered simultaneously. Alterations in the SBF were produced either by orthostatic changes or by application of local heat or cold. The insulin absorption rate was related to the SBF in a curvilinear way with an almost linear relation at SBF below 2-3 ml-(min-100 g)-1, whereas at SBFs above this value the insulin absorption rate increased less than proportional to SBF. Capillary diffusion capacity of the injected insulin was 0.0145–0.0874 ml(min-100 g)-1; indicating that insulin is absorbed in a polymeric form. This was supported by studies of insulin diffusion in agar gel at 37 d`C, showing that insulin in the normal pharmacological concentration diffuses as a molecule of about 46,000 MW. In conclusion, the absorption of short-acting soluble insulin is curvilinearly related to the SBF. This can be explained by a diffusion-limited transport of insulin in the interstitial space, and increasing transcapillary transport of insulin at increasing blood flow rates caused by recruitment of capillaries, thus increasing exchange surface area and decreasing diffusion distance. Continue reading >>

Diabetes And Insulin

On this page: Diabetes mellitus (diabetes) is a chronic and potentially life-threatening condition where the body loses its ability to produce insulin, or begins to produce or use insulin less efficiently, resulting in blood glucose levels that are too high (hyperglycaemia). Blood glucose levels above the normal range , over time, can damage your eyes, kidneys and nerves, and can also cause heart disease and stroke. An estimated 280 Australians develop diabetes every day. Diabetes is Australia's fastest-growing chronic disease. The main types of diabetes are type 1, type 2, and gestational diabetes. Type 1 diabetes Type 1 diabetes develops when the cells of the pancreas stop producing insulin. Without insulin, glucose cannot enter the cells of the muscles for energy. Instead the glucose rises in the blood causing a person to become extremely unwell. Type 1 diabetes is life threatening if insulin is not replaced, and people need to inject insulin for the rest of their lives. Type 1 diabetes often occurs in children and people under 30 years of age, but it can occur at any age. This condition is not caused by lifestyle factors. Its exact cause is not known but research shows that something in the environment such as the rubella virus can trigger it in a person that has a genetic risk. The body’s immune system attacks and destroys the beta cells of the pancreas after the person gets a virus because it sees the cells as foreign. Most people diagnosed with type 1 diabetes do not have family members with this condition. For more information about symptoms, visit the Diabetes type 1 fact sheet. Type 2 diabetes Type 2 diabetes develops when the pancreas does not make enough insulin and the insulin that is made does not work as well as it should (also known as insulin resistan Continue reading >>

Insulin Injection Sites: A Review

When it comes to injecting insulin, the stomach, the buttocks, the back of the arm and the thigh have something in common. They usually contain enough fatty issue to be good depots for insulin administration. As any educator will tell you, insulin should be injected into fat. If injected directly into muscle, aside from being painful, it will be absorbed much too rapidly. The insulin may reach your blood stream before your digestive system has the time to release glucose from the food you eat. (There are other areas on the body, for example, the breasts, which have adequate fatty tissue but have not been sufficiently studied to determine their absorption rates.) Each of these approved areas absorbs insulin at a slightly different rate, and knowing this can help you make the best decision about where to inject depending on your blood glucose. In general, insulin is more quickly absorbed from the stomach followed by the arm, the thigh, and the buttocks. For example if your blood glucose is low before a meal, you may want to inject into the buttock area because insulin is absorbed most slowly here. On the other hand, if you are hyperglycemic the stomach may be the best choice as it has the fastest absorption rate. This variability is most prominent with NPH and regular insulin and not as much a factor with the rapid acting insulins. Rotate your sites Injecting insulin into the same site over and over again can lead to the fat below the skin becoming hard and lumpy. Aside from being unsightly, it can change the way your insulin is absorbed so you won’t easily know when the insulin will start working or peak. Tips for Injecting Insulin Stomach: Stay at least two inches away from the belly button, or any scars or moles. Thigh: Inject at least 4 inches (or approximately one Continue reading >>

Insulin Absorption Rate For The Tongue

Diabetes Forum The Global Diabetes Community This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies. Learn More. Get the Diabetes Forum App for your phone - available on iOS and Android . Find support, ask questions and share your experiences. Join the community You guessed it , due to a headphone cable getting caught in my chair , I have injected bolus into my tongue. I pulled out the needle pretty quickly and only had 2 units selected in the pen. Rather painful and needless to say I will check my bloods over the next hour or so. Quite possibly the stupidest thing I've done this decade. The insulin absorption rates are well documented for thighs, arms , buttocks etc etc but does anyone have any experience in the tongue area as an injection site ? I'm sorry you'll just have to explain in a bit more detail how you came to inject in your TONGUE!!!? how the hell.........???!! Well I think the tongue is one, if not, fasting repairing organs in the body....... LOL I'm still trying to figure out how you managed it! Its quite comical in hindsight. I prepared my pen i.e inserted and unsheathed the needle and selected 2 units. I then pushed back my office chair in order to reach my belly unobstructed. My headphone cable was entangled around the chair arm and the force of the movement pulled my head towards the open needle, Bizarrely I had my tongue out otherwise I would have injected into my lower lip :-( If anything I would suggest based on the fact your tongue is full of blood and vessels that the absorption rate would be incredibly quick compared to any other body part. I am also curious - how did you manage the tongue, and also ouch poor you.. As JuicyJ mentioned I also think it would be quite quick too. Would be interesting to know, Continue reading >>

Special Article New Insulin Delivery Recommendations

Correct technique in insulin delivery is critical for optimal control of diabetes. This article reviews the most recent studies in the field and then offers new injection and infusion recommendations for insulin users. It is meant to complement and extend the injection recommendations published in 2010.1 These latest recommendations were based on the results of the fourth Injection Technique Questionnaire (ITQ) survey (published elsewhere in this issue). From February 2014 through June 2015, 13,289 insulin-injecting patients with diabetes from 42 countries participated in the ITQ survey, one of the largest multinational studies of its kind. A smaller Infusion Technique Questionnaire survey was undertaken concurrently with the ITQ in 356 patients using continuous subcutaneous insulin infusion (CSII) in four countries and informed the drafting of the new infusion recommendations. The ITQ survey results (fo Continue reading >>

Insulin Absorption Facts And Myths

Blood glucose checks can be frustrating. Sometimes I think I am doing everything right - I know my target, I know the carb count of any food I'm about to eat, I know my insulin-to-carb ratio, and I understand my insulin sensitivity. But even if I pay close attention to these factors, my blood glucose results can be mysteriously higher or lower than I expected. What people may not know is that of the many things that can influence blood glucose, insulin absorption is one of the most important. Let's look at some common misconceptions: MYTH: My blood glucose should not be affected by where I take my shot, or where I insert the catheter for my pump. After all, insulin going in is insulin going in! FACT: Actually, the injection site you pick can affect how quickly the insulin is absorbed. For example, insulin is usually absorbed faster in the abdomen - sometimes almost twice as fast - than in other sites such as the thigh or arm. MYTH: Insulin will always be absorbed faster if I inject in my abdomen. FACT: Well, not exactly. There are additional things to consider, says Dr. Howard Wolpert of the Joslin Clinic: If you take your shot or place your pump catheter in a spot on your abdomen where there is more fat underneath the skin, insulin may be absorbed more slowly. For example, the middle of the abdomen may be fattier than the side. Even though it might seem more comfortable to take insulin here, because there are fewer nerve endings, your insulin may not be absorbed as quickly as you want. You should avoid using the same injection site continuously, because this can cause scar tissue to build up. Scarring at infusion sites is often seen in pump wearers, or those who have had surgery, but it is also seen in any people who use the same injection site constantly. Scars can ca Continue reading >>

Injection Techniques, Site & Absorption

General Your nurse will have shown you where the suitable injections sites are, on the abdomen, arm, thigh, and buttock. Do try to change you injections sites. Some people say use the same site at the same time of the day, using other sites at other times, but see below. As exercise increases absorption, this may work out well. If you are busy walking at work, the arm may be best. If you have a phobia and are afraid to injection certain sites, you need to ask your nurse for help and ideas. Massage of the injection area, exercising muscles in the area of the injection site, and higher temperatures (beware of hot baths!) all increase the rate of absorption. Absorption is quickest in order abdomen>arm>thigh>buttock. There is more variation in the absorption of the more longer acting insulins (NICE 2004 p85 a large file). in the UK virtually all insulin is U100....100 units per ml do not inject insulin past its expiry date, stored at the correct temperature in domestic fridges; it must not be frozen as that destroys it the best place to inject insulin is into the fatty layer beneath the skin inject at a 90 degree angle using a short 6 or 8 mm needle Abdomen, thighs, or buttocks are ideal injection areas insulin is absorbed more quickly form the abdomen vary injections sites to prevent hard lumps forming under the skin..these lumps affect insulin absorption (it may take longer or less time to work...this is unpredictable) there is no need to clean the skin first Insulin injections should be made into the deep subcutaneous fat; use needles of length appropriate to you. The abdominal wall is the best choice for meal-time insulin injections Use one anatomical area for the injections given at the same time of day, but to move the precise injection site around in the whole of the Continue reading >>

When Does Insulin Start Working? Many Factors Affect Absorption

A major challenge in diabetes therapy is to match the insulin with food and exercise. Changes in the amount of time that it takes for insulin to be absorbed into the bloodstream can be a critical factor in obtaining diabetes control. Both the amount of insulin and its timing are critical, and both of these can be influenced by a wide range of variables. Here is a list of factors which every person taking insulin should be aware of. Type of Insulin The type of insulin is the most obvious change that influences insulin absorption. Regular insulin is absorbed faster than NPH or Lente insulin, which are absorbed faster than Ultralente insulin. Mixing insulin can sometimes change their absorption kinetics. Regular and NPH insulin can be mixed in virtually any proportion with little or no effect on their action. The insulin of the Lente series, Lente and Ultralente insulin, are very high in zinc and can slow the absorption of regular insulin by about fifteen minutes. Species of Insulin The species of insulin can also be important. For many patients human insulin works faster than pork or beef insulin and may not last as long. For Regular insulin, this is often an advantage, as we want this insulin to work fast. But for NPH insulin, it may mean that the insulin will not last through the night, especially if you are taking only a single shot of insulin each morning. Site of Injection The site of injection can be critical. It can take up to 50% longer for insulin to be absorbed from the leg than from the abdomen (or stomach area). Not only does the time for absorption of insulin vary with the site, but so does the total amount absorbed. Regular insulin peaks in the bloodstream about 90-120 minutes after it is injected into the thigh. Because of the subcutaneous enzymes, only abo Continue reading >>

Strategies For Stabilizing Insulin Absorption Rates

Strategies for Stabilizing Insulin Absorption Rates Last week, I introduced the topic of insulin absorption . I laid out the basics, and then gave a nice, cheery list of all the things that can go wrong with how our bodies handle incoming insulin. This week, well revisit that list and talk about some strategies for managing this issue. The first issue we went over last week was site selection. For both infusion sites and for shots, this is very, very important. Repeated use of a single site leads to the buildup of scar tissue, another issue I highlighted last week. Over time this scar tissue can impede insulin absorption so badly that an area of your body simply becomes unusable for taking in insulin. Scar tissue CAN heal over time, but areas with severely built up scar tissue can take years to recover and become absorbent again. The better solution is to avoid developing scar tissue in the first place (as much as possible, at least). Rotating our injection sites is key. The methods people use vary (some people have said they rotate their sites in the shape of a W on either side of the belly button, moving left to right across the belly, then moving on to the next are of the body and following a similar pattern there; others rotate in a clockwise circle around the belly button [at least 2 inches away], and so on). But there are a few general rules. When you move to a new site, it should be at least 2 inches from the last site, particularly for insulin pumps, as the previous area can become overly saturated with insulin, and so the next round of insulin needs to be far enough away to ensure a clean site. You should keep track of your rotation and follow a pattern some people even use a site journal to log their sites (which can also help detect if certain areas absorb m Continue reading >>

Pharmacokinetics And -dynamics Of Insulin Absorption

Exogenously administered insulin will never be able to exactly mimick the effects of insulin endogenously released by the pancreas. The main reason is that the pancreas releases insulin into the portal vein, so that the insulin passes the liver first. There, more than 50% of insulin is extracted, and as a result hepatic exposure to insulin is high, and peripheral (muscle, fat) exposure to insulin is low. When exogenous insulin is administered -whether i.v., s.c., i.m. or otherwise- it is distributed throughout the circulation, exposing the peripheral organs to relatively high and the liver to relatively low levels of insulin. Another problem is that the pancreas releases insulin in small bouts at short intervals, in direct response to the ambient level of glucose, whereas the dose of exogenously administered insulin thusfar is predetermined. The precise effects over time of the various exogenous insulins are however also dependent on their pharmacokinetic and pharmacodynamic characteristics and the mode of administration. Studying pharmacokinetics and -dynamics The traditional method to assess the pharmacokinetics (the plasma levels of insulin over time) and the pharmacodynamics (the resulting effects on glucose over time) of exogenous insulins is the isoglycaemic clamp study. In this, the study insulin is injected and i.v. glucose is infused to maintain a stable level of glycemia. The Glucose Infusion Rate (GIR) is considered to represent the pharmacodynamics of the insulin. When studying other subjects than those with type 1 diabetes -who do not have endogenous insulin secretion- additional steps have to be taken to make sure that (residual) endogenous insulin does not interfere with the interpretation of the results. While the technique has its disadvantages, it usua Continue reading >>