Leaky injection site?

[Postitnote]

Hi there! I am sure that the answer is very simple but, when I take a larger dose of short acting (20 + units), the insulin, on several occasions, leaks back out once I've removed the pen.

I hold the pen in for 30 seconds to a whole minute, but it doesn't make a difference. I generally inject into my thigh or tummy but it doesn't make a difference to whether the insulin leaks back out or not.

Is the only answer to split the dose so, for a 20 unit dose, I inject 10 units twice? This is fine but annoying - I'd rather not stab myself more than I need to!

 

[noblehead]

Is the only answer to split the dose so, for a 20 unit dose, I inject 10 units twice?

For a 20+ dose I can't think of any other way if your leaking from a single dose.

Plus I don't think the insulin would absorb very well injecting a high dose of insulin into a single site, I'm sure I've read somewhere that doses over 7-8u should ideally be split.

 

[GrantGam]

How big is the leak exactly? I always seem to have a small bit of insulin on my skin (in all areas after injecting) but it's not what I'd call a leak.

Are your needle lengths correct? Do you find that there is a small lump under your skin after injecting? That combined with the leaking insulin issue you're having might mean you require longer needles:

http://www.inputdiabetes.org.uk/pen-needles/

Grant

 

[Postitnote]

Oo! @noblehead! I didn't know that about large single doses. I will continue to split it then! @GrantGam1337, this is more than just that little bubble of insulin that sits on top of the site... I hadn't thought about the needle length. I use 4mm but I have some old (I will check the date!) 5mm needles - I will see if they make a difference.

Thanks both!

 

[rockape37]

Never ever been advised to split larger doses of insulin up.

When i was on MDI i was regularly injecting doses of 20 and as much as 40 units with no problem at all

I sometimes got a what i would call a droplet on my skin after injecting but would put this down to what may have been left in the needle after the injection had been taken.

Just a thought could it be a bad injection site thats limiting the insulin being absorbed?

Maybe try a completely different injection site nd see how it is.

Regards

Martin

 

[slip]

Do you 'pinch an inch' when injecting? I'd suggest trying different sized needles. Can't say I've been told to split dose anything over a certain number of units. But having 'spillage' must make it really hard to stay in control!

On another (postit)note(!) though what are your carb ratios like? I know we're all different but I'd have to have a serious carb heavy meal to have to inject 20+u.

 

[GrantGam]

Oo! @noblehead! I didn't know that about large single doses. I will continue to split it then! @GrantGam1337, this is more than just that little bubble of insulin that sits on top of the site... I hadn't thought about the needle length. I use 4mm but I have some old (I will check the date!) 5mm needles - I will see if they make a difference.

Thanks both!

I think pen needles go as high as 8mm, but the latter tends to be reserved for those who are on the obese side of life.

Hope you have some luck with splitting the dose and/or longer needles.

Regards,
Grant.

 

[Postitnote]

@slip , my breakfast ratio is 1:3. I'm 35 weeks pregnant so am suffering from a bit of insulin resistance! usually my ratio is 1:12. Can't wait to get back to my old routine!

I have tried different sites; doesn't seem to make a difference although I'm not being particularly scientific about it!

8mm is nuts.

 

[GrantGam]

8mm is nuts.

And long!

 

[slip]

@Postitnote ah! that explains that then - Congratulations!

I was going to write some witty comment about the 8mm needles but what's the point..........

 

[noblehead]

Never ever been advised to split larger doses of insulin up.

Likewise, I'm sure I first heard of it on this very forum, could have been from the member @SamJB who had read about it in the Bernstein book (although I may be mistaken).

Found this though that says as much:

Does the size of the insulin dose affect its absorption?

Yes. The absorption of insulin may be slowed if the dose is large. It may be beneficial to split large doses into two separate injections. When giving two separate injections, the injection sites should be spaced at least two inches apart.

https://www.bd.com/us/diabetes/hcp/main.aspx?cat=3065&id=63271

On one of my pump training days it was mentioned that doses above 7u should be extended (or to use a dual-wave bolus) so maybe the technique is being more widely recognised.

 

[rockape37]

It's only now that I'm on a pump that I've been advised to Dual wave (split my dosage) on doses 10 units and above and as already mentioned its to improve insulin absorbtion. And it works.

Regards
Martin

 

[richyb]

just a thought but I have found that when withdrawing the pen, withdraw slowly out of the skin. By doing this it allows the skin that is tight on the needle to seal around the point of the needle as the last bit is coming out

 

[steve_p6]

Im doing 36u of Tresiba on a 6mm needle without problem if that helps.