diabetestalk.net

Insulin Injection Site

Injection Site Rotation

Injection Site Rotation

The systematic switching of insulin injections from one site to another. For years, doctors have emphasized the need for people with diabetes to rotate their injection sites rather than injecting into the same place each time. Injecting into the same spot can cause lipohypertrophy, the buildup of fat under the skin, which can slow the absorption of insulin, or lipoatrophy, the wasting of fat under the skin, which can be unsightly. (Lipoatrophy is less likely to occur in people using only human insulin.) The best places to inject insulin are the upper arms, the thighs, the buttocks, and the abdomen (at least two inches away from the navel). Because the rates of absorption vary considerably from one body region to another, the American Diabetes Association (ADA) currently recommends rotating injection sites within body regions rather than rotating to a different region with each injection. Insulin is absorbed fastest from the abdomen, followed by the arms, the thighs, and the buttocks. (However, exercising an arm or leg after an injection can increase blood flow and speed insulin absorption from those areas.) The ADA recommends taking this variability into account when choosing injection sites. Everyone absorbs insulin somewhat differently, so the best way to find out what effect a given injection site is having is to monitor your blood glucose levels. Paying close attention to how you rotate your injection sites can help to eliminate high and low swings in blood glucose level. This article was written by Robert S. Dinsmoor, a Contributing Editor of Diabetes Self-Management. Disclaimer Statements: Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site Continue reading >>

7 Tips To Stop Injection Site Bruising

7 Tips To Stop Injection Site Bruising

Integrated Diabetes Services (IDS) provides detailed advice and coaching on diabetes management from certified diabetes educators and dieticians. In 2015, Insulin Nation will be featuring a regular Q&A column from IDS that answers questions submitted from the Type 1 diabetes community. Q: Is it common to get bruises at the site of injection? What can you do about that? A: There are many reasons that an injection site might develop a bruise. Try some of these techniques to decrease the chances of bruising: Ice the injection site for about 30 to 60 seconds prior to giving the injection.The cold helps to shrink away the capillary blood vessels which may get punctured during a shot. If the bruising happens specifically in your abdomen, make sure you are not injecting too close to your belly button. sponsor Shorter needles tend to cause more bruising than longer needles. If you are on blood thinners like warfarin, aspirin, or Plavix, you may be more at risk for bruising. Discuss this with your healthcare provider. Make sure you are injecting at a 90 degree angle to your skin, and not on a slant. Always use a new needle or pen cap for insulin pens. Reusing needles causes more trauma to the tissue. Switch injection sites. Repeated injection into the same area can cause bruising, as well as the development of scar tissue. Have a Question? Insulin-Quiring Minds is a free service of the clinical team at Integrated Diabetes Services LLC. Submit your questions to [email protected] All questions will be answered, and yours may be chosen to appear in Insulin Nation. About Integrated Diabetes Services Integrated Diabetes Services provides one-on-one education and glucose regulation for people who use insulin. Diabetes “coaching” services are available in-person and Continue reading >>

How To Improve The Insulin Injection Experience

How To Improve The Insulin Injection Experience

If you have type 1 diabetes, or if you have type 2 and have recently begun injecting insulin, you may have a bit of trouble getting used to the process of preparing and administering your own insulin shots. Andrea Penney, RN, CDE, of the Joslin Diabetes Center, says that injection technique is important to master not only for accurate dosing, but for comfort, too. "With proper practice and good technique, you can avoid pain during an injection," she states. Penney sat down with us recently to answer some common questions about insulin injection. If after reading and practicing insulin injections you still find you’re having trouble, Penney suggests seeing a Certified Diabetes Educator for more assistance. Q: How do I decide where to inject? A: People often select injection sites based on many factors: accessibility, presence of fatty tissue, and rate of insulin absorption (which will be discussed shortly). As a result, popular sites for injection include the stomach, outer thigh, the back of the arm (between the shoulder and the elbow), or the upper outside "wallet" area of the buttock (but not into the lower buttock area). Q: Once I decide on a location for an injection, how do I pick the right "spot"? A: Here are some easy guidelines: -Stomach If you’re going to inject into the stomach, stay at least two inches away from the bellybutton and/or any scars you may already have when using the abdomen for injections. -Thigh For an injection in your thigh, inject at least four inches or about one hand’s width above the knee and at least four inches down from the top of the leg. Do not inject insulin into your inner thigh because of the large number of blood vessels and nerves in this area. - Arm The area between the shoulder and elbow on the outside of the arm is usua Continue reading >>

Injecting

Injecting

Injections are often all that people think of when you mention diabetes. But if you're new to Type 1 diabetes, injecting yourself (or having someone else do it for you) can be quite easy. You can't get away from the need to inject, but these tips can make it a bit easier. There's no escaping the fact that injecting can be a bit uncomfortable, especially the first few because you may be tense and anxious. We can't guarantee that this will go away, but as you become more confident and relaxed, injecting will become easier. Where to inject Well, you have a choice of four main injection sites – your stomach, bum, arms or thighs. All these body parts have a wide skin area so you can inject in lots of different places within these sites. This is called 'rotating' your injection sites and is really important. If you keep injecting in the same place small lumps may build up under your skin. These will make injections less effective and you won't appreciate the lumps left behind. You might find your arms are a bit on the skinny side – most people's are when compared to, say, your legs. Talk to your nurse about whether it's OK for you to inject in your arms. When injecting just before you do some physical activity, avoid injecting the limb you are just about to use (for example, don't inject your thigh just before playing football). If you do inject the limb you are just about to use, this will speed up the action of insulin and make a hypo more likely. Heat can also speed up the action of your insulin after it has been injected, so be careful if it's a hot day. Other things, such as taking a hot bath or a massage, can have an effect too – so, if you are doing any of these things, you have to check your blood glucose levels more often. Your comments "I've been Type 1 diabet Continue reading >>

Lumps And Bumps From Insulin Therapy

Lumps And Bumps From Insulin Therapy

What are these lumps and bumps at my injection sites? Lumps and bumps from insulin are called lipohypertrophy. This is a medical word for a lump under the skin from an accumulation of fat at the site of many insulin injections. Scar tissue may also develop at the sites. Why does this happen? This happens due to the action of insulin on the fat cells. Insulin can actually cause fat cells to increase in size. It is generally seen when one uses the same area for insulin injection or infusion. It happens most often in areas that are easiest to inject insulin or place infusion sets-on both sides of the belly button and on the sides of the thighs. What happens when you have this? You may notice a thickening of this skin and areas of lumps and bumps. This was more evident with the older preparations of insulin where the skin changes were more evident. The changes may be very subtle with the newer insulin analogs so it is important to actually feel the areas that you use to inject or infuse insulin. You want to firmly stroke the areas in a sweeping motion to feel for any lumps. Does it affect your glucose control? Infusing insulin into areas of lipohypertrophy can affect your glucose control. Insulin is not always well-absorbed in these areas. You may find that your glucose control is not what you expect it to be. The more damaged the area is the more likely it is that glucose control will be affected. Sometimes the areas of lipohypertrophy have damaged nerve endings and you don’t feel your infusion set going it at all. This is clearly a sign of a damaged area. How is it prevented? Rotate your infusion sites! It is important to use different sites to prevent lipohypertrophy. You might want to use a calendar or body map to be sure that you are rotating you sites frequently. Av Continue reading >>

Lipodystrophy In Insulin-treated Subjects And Other Injection-site Skin Reactions: Are We Sure Everything Is Clear?

Lipodystrophy In Insulin-treated Subjects And Other Injection-site Skin Reactions: Are We Sure Everything Is Clear?

Go to: Definition of Lipodystrophy Lipodystrophy (LD), a disorder of adipose tissue, is one of the most common complications of subcutaneous insulin injections and may present as either lipohypertrophy (LH) or lipoatrophy (LA). The latter is defined as a large, often deep, retracted scar on the skin that results from serious damage to subcutaneous fatty tissue [1]. Several features of LA suggest an immunological etiology [2]: (1) it is more frequent in patients with type 1 diabetes, and mostly affects women—who often have other signs of autoimmunity; (2) it is often characterized by the presence of mast cells and eosinophils in biopsy specimens and may be responsive to topical 4% cromolyn sodium preparations (an inhibitor of mast cells); (3) it seems to be the result of a lipolytic reaction to impurities or other components in some insulin preparations, as its prevalence has dropped to only 1–2% with the increasing use of purified insulin [3, 4]. LH is a thickened ‘rubbery’ tissue swelling which is mostly firm but may occasionally present as a soft lesion as well, and thus it is easily missed during a standard medical examination. Although the exact etiology of LH is unclear, several local factors appear to be at play, including both the insulin molecule per se—with its strong growth-promoting properties—and repeated trauma caused by poor injection habits, such as infrequent/missed injection site rotation and/or frequent needle reuse [1]. However, a large body of evidence also lends support to a significant association between LH and many other factors, including female sex, low socioeconomic level, high body mass index, as well as long-standing disease and/or insulin treatment. LH lesions are generally correctly identified during the course of any accurate Continue reading >>

Insulin Injection Sites

Insulin Injection Sites

insulin injection sites body tissue areas that allow optimal use of subcutaneous injections of insulin. The choice of sites can affect the rate of absorption and peak action times, but repeated use of the same injection site can lead to localized tissue damage, resulting in malabsorption of insulin. These problems are minimized by systematic rotation of injection sites within the selected anatomical area. Want to thank TFD for its existence? Tell a friend about us, add a link to this page, or visit the webmaster's page for free fun content. Link to this page: insulin injection sites Continue reading >>

Injection Sites

Injection Sites

Tweet If you inject insulin regularly, you will need to vary the areas of skin you inject your insulin into to ensure your insulin gets absorbed consistently. Also, by rotating your injection sites, you can avoid developing stiffer, lumpy skin helping you to feel happier. Which areas can be injected into? Ideal areas to inject into are parts of the body with a decent layer of fat. The belly, upper arms, thighs and buttocks are commonly used. Note that some parts of the body absorb insulin quicker than other parts. The quickest area to be absorbed from is the belly, followed by the upper arm, then the thighs and lastly the buttocks. [24] Charity Diabetes UK warn that the arm may not always be a suitable injection for people with less body fat [25] as there is a greater chance of injecting into a muscle which could lead to hypoglycemia. Injecting in the same general area for the same type of meal To have consistent absorption of insulin, it’s recommended to inject in the same general area of the body for the same type of meal. For example, for breakfast it may be a good idea to inject short term or bolus insulin into the belly. For long acting or basal insulin, it might be beneficial to inject into the legs or buttocks. You can discuss which injection site is best for each meal with your health team. Rotating your injection sites If you inject regularly, it’s recommended to ‘rotate’ your injection sites. Rotating your injection site means using a different spot to inject into to prevent injecting into the same place each time. For example, if you injected into the left side of your belly yesterday at breakfast, you could inject into the right side of your belly for the next day’s breakfast. You’ll soon need to inject into the left side of your belly again, but Continue reading >>

Choosing An Injection Site

Choosing An Injection Site

Do not take Lantus® during episodes of low blood sugar or if you are allergic to insulin or any of the inactive ingredients in Lantus®. Do not share needles, insulin pens, or syringes with others. Do NOT reuse needles. Before starting Lantus®, tell your doctor about all your medical conditions, including if you have liver or kidney problems, if you are pregnant or planning to become pregnant or if you are breast-feeding or planning to breast-feed. Heart failure can occur if you are taking insulin together with certain medicines called TZDs (thiazolidinediones), even if you have never had heart failure or other heart problems. If you already have heart failure, it may get worse while you take TZDs with Lantus®. Your treatment with TZDs and Lantus® may need to be changed or stopped by your doctor if you have new or worsening heart failure. Tell your doctor if you have any new or worsening symptoms of heart failure, including: Sudden weight gain Tell your doctor about all the medications you take, including OTC medicines, vitamins, and supplements, including herbal supplements. Lantus® should be taken once a day at the same time every day. Test your blood sugar levels while using insulin, such as Lantus®. Do not make any changes to your dose or type of insulin without talking to your healthcare provider. Any change of insulin should be made cautiously and only under medical supervision. Do NOT dilute or mix Lantus® with any other insulin or solution. It will not work as intended and you may lose blood sugar control, which could be serious. Lantus® must only be used if the solution is clear and colorless with no particles visible. Always make sure you have the correct insulin before each injection. While using Lantus®, do not drive or operate heavy machinery until Continue reading >>

Choosing Best Body Site For An Insulin Shot

Choosing Best Body Site For An Insulin Shot

In the past, doctors and nurses told patients to rotate their insulin shots to different sites on their bodies. Now we know that it's best to take insulin shots in the part of the body that matches the insulin action a person wants. See Illustration: Sites for Injecting Insulin Injection Areas and Action Insulin enters the bloodstream faster from some areas of the body than from others. Where you take your shot can affect your blood sugar levels. Generally, insulin enters the blood: Fastest from the abdomen (stomach area). A little slower from the arms. Even more slowly from the legs. Slowest from the buttocks. Exercising can also speed up the amount of time it takes for the insulin to enter your blood. You can figure out where to take your shot based on how quickly or slowly you want the insulin to enter your bloodstream. For example, if you're going to be exercising, such as walking or doing any kind of lifting, you probably don't want to take your shot in your leg or arm. Exercising those areas quickens the amount of time it takes for the insulin to get into your blood stream. This can cause your blood sugar to drop suddenly during or right after you exercise. If you plan to eat right after taking your shot, you might use a site on your stomach. That way the insulin will be available faster to handle the rise in your blood sugar after the meal. Rotate Sites in the Same Area Follow these guidelines when you choose a site to take your shot. Try to be consistent in where you take your shots. Always take your shot of fast-acting insulin in the stomach or arm. Take slower-acting insulin in the leg or buttocks. Try to avoid using the exact spot you used for your last shot. For example, space your next shot just an inch or so from your last previous shot. If you use the sam Continue reading >>

Rotating Your Injection Sites

Rotating Your Injection Sites

If you inject insulin three or more times a day then it’s a good idea to rotate your injection sites. Injecting in the same place much of the time can cause hard lumps or extra fat deposits to develop. These lumps are not only unsightly; they can also change the way insulin is absorbed, making it more difficult to keep your blood glucose on target. Follow these two rules for proper site rotation: Same general location at the same time each day. Rotate within each injection site. Same Time, Same General Location Insulin is absorbed at different speeds depending on where you inject, so it's best to consistently use the same part of the body for each of your daily injections. For example, do not inject your lunch bolus dose in the abdomen on Monday and in the thigh on Tuesday. If you have picked the thigh for your evening injection, then continue to use the thigh for all of your evening injections. According to Eli Lilly, the leading manufacturer of insulin, most insulin enters the blood: Fastest from the abdomen (stomach) A little slower from the arms Even slower from the legs Slowest from the buttocks Unless your doctor has told you otherwise, it is a good idea to inject your breakfast and lunch bolus doses into the abdomen. Insulin is absorbed fastest when injected into this area. Fast absorption is needed at mealtimes to cover the carbohydrates you are about to eat. On the other hand, your supper or bedtime dose of long-acting insulin could be injected into the thigh, buttocks, or upper arm. That's because you want the long-acting insulin to take effect gradually and cover your needs throughout the night. If you mix two types of insulin in one shot, you can inject into the abdomen, arm, thigh, or buttocks. Rotate Within an Injection Site To avoid developing hard lump Continue reading >>

Severe Injection Site Reaction To Insulin Detemir

Severe Injection Site Reaction To Insulin Detemir

Insulin detemir is a new long-acting insulin analog. Though generally well tolerated, injection site reactions have been reported in 2% of insulin detemir users (1). Most commonly, these untoward reactions manifest as mild injection site erythema or discomfort and seldom lead to discontinuation of the product. Herein, I report the case of a patient with a severe local reaction to insulin detemir necessitating its withdrawl. A 37-year-old Caucasian woman with a 25-year history of type 1 diabetes was switched from NPH (Humulin N; Eli Lilly) to insulin detemir (Novo Nordisk) because of poor glycemic control characterized by undue variability of her blood glucose readings and an elevated HbA1c. She was also being treated with insulin lispro (Eli Lilly), which she remained on. She had no previous history of injection site problems. With both the previous and the new insulin, she maintained the same proper injection technique and injected, as was her custom, into her abdominal wall. The patient developed injection site problems within hours of her very first injection of insulin detemir with a characteristic and reproducible pattern occurring with all subsequent injections, ultimately necessitating withdrawl of the insulin within a few days of its institution. Within 6 h of an injection of insulin detemir she would develop a slightly raised, indurated, nonerythematous, minimally uncomfortable, nonpruritic, nontender lesion of ∼3 cm. Over the subsequent 6 h, a lesion would expand in size reaching a diameter of 5–6 cm and become erythematous (without central sparing), warm, and moderately tender. Over the subsequent 12 h, a lesion would enlarge further, reaching a diameter of 10 cm, and become markedly indurated, hot, and extremely painful. Over the subsequent 12 h, a lesio Continue reading >>

Best Insulin Injection Sites: Absorption Time And Rotation

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 >>

Insulin Site Rotation

Insulin Site Rotation

Tweet If you have to start injecting, you are told to rotate your sites. A site is the place you put your injection in. The idea is not to use the same site too often. Rotating where you test from Therefore, you should consider using a system whereby you maybe either rotate clockwise around your stomach so that each injection is at least an inch away from the last one - hey, go anti-clockwise sometimes, what the heck! Or rotate around your legs, arms, stomach and (for some of us old-timers, we were told to use our ‘upper, outer buttock region as well, if you can still reach them - this area tends not to get include much these days, but still a viable option). Does injecting insulin hurt? It sounds easy enough, but there are issues with site rotation when you have a long-term medical condition such as diabetes. Tweet Type 2 diabetes mellitus is a metabolic disorder that results in hyperglycemia (high blood glucose levels) due to the body: Being ineffective at using the insulin it has produced; also known as insulin resistance and/or Being unable to produce enough insulin Type 2 diabetes is characterised by the body being unable to metabolise glucose (a simple sugar). This leads to high levels of blood glucose which over time may damage the organs of the body. From this, it can be understood that for someone with diabetes something that is food for ordinary people can become a sort of metabolic poison. This is why people with diabetes are advised to avoid sources of dietary sugar. The good news is for very many people with type 2 diabetes this is all they have to do to stay well. If you can keep your blood sugar lower by avoiding dietary sugar, likely you will never need long-term medication. Type 2 diabetes was formerly known as non-insulin-dependent or adult-onset dia Continue reading >>

What Skin Problems Occur At Insulin Injection Sites?

What Skin Problems Occur At Insulin Injection Sites?

Two main skin problems can occur at insulin injection sites: lipoatrophy and hypertrophy. With lipoatrophy, fatty tissue under the skin disappears, causing dents in the skin at the injection site. Hypertrophy is the overgrowth of cells, usually fat cells, that makes the skin look lumpy. It can look similar to scar tissue. By rotating the injection site, you can avoid some of these problems. There is also the possibility that some of the problems are caused by the type of insulin you are using. Lipoatrophy is probably caused by an immune reaction, although its exact cause is not known. Your body is responding to insulin as an injected “foreign” substance. This problem is not common with human insulin. Make sure you are using highly purified insulin, preferably human. Hypertrophy is not an immune reaction, so you don’t have to change your insulin if you are having this problem. But you do need to change injection sites to avoid this. When the same sites are used over and over again, fat deposits can accumulate in the area. This is also called lipohypertrophy. You may be reluctant to change because injections seem less painful in these areas. This can be true because the hypertrophy can numb the area. On the other hand, injections can sometimes be more painful in these areas. The abnormal cell growth can limit the absorption of your insulin. Do not inject into the lumps. Insulin action can be restricted by not being able to move through the tissue. Inject away from the lumps and remember to rotate the sites. Ask a member of your health care team to check your injection sites periodically. Continue Learning about Insulin Videos Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. Continue reading >>

More in insulin