What's the correct technique to inject?

[stephenT2]

A few weeks ago I was changed from tablets, onto injecting long lasting (Levimir) insulin (NovoPen).

To start with I was on 10 units, this was no problem, over and done with in a few seconds, virtually no pain/discomfort. However, I am now up to 60 units, and there is certainly discomfort once I pass the 20 unit mark. Is it better to press the release button very slowly, or should you just press it hard and get it over as quick as possible?

I also get rashes now, with hard patches and my tummy feels like a pin cushion and itches. I change the injection site every time.

Any advice appreciated.....

stephen

 

[iHs]

Hi Stephen

The best way to inject large doses of insulin is to press the button down slowly so that it doesnt sting.

If you are injecting the Levemir in your stomach, try using your backside to see if the skin irritation goes. If this doesnt fix the problem, then you might have to change to another background insulin such as Lantus as there is a known problem with skin irritation for some using Levemir.

 

[loopy-loo]

Hi stephen,

You might like to try splitting your dose. Many people benefit from this as levemir tends to have a 12hour 'life'
also- this way, you may find injecting 30 units less uncomfortable.

Regards
lindsey

 

[fergus]

Lindsey's point is a good one. Many so-called 24 hour insulins don't in fact last 24 hours. I use Lantus, which for me is pretty much finished in in 20 hours. When I started splitting the dose (one before bed and one in the morning) I had much better coverage, and no more night-time hypos.
The other point about such large doses is that there is a large variability in absorbtion when you inject more than 7 or 8 units at a time. Even if you split your doses in two, I'd be tempted to split each half in two again so that your injection sites cope better. For example, a 30 unit bed-time dose could be split with 15 units in one sie and the balance in another.
I know it sounds like you'll turn into a pin-cushion, but the injections themselves will become painless once you get good at them. The benefits will outweigh the risks for sure.

All the best,

fergus

 

[stephenT2]

Many thanks for all the replies.

I can't split dose between morning and night, as my team are trying to get my morning fast level below 10mmol (Still around 14). But the suggestion of splitting sites in the evening I've now started.

However, as of today, I'm now on 92 units, so may well start splitting it three times!

My feeling is that 92 units is a lot - anyone take more than that?

stephen

 

[fergus]

I think you're right, Stephen, 92 units is a helluva lot.
When measurements of healthy non-diabetic serum insulin levels were first carried out, a range between 0.4 and 0.5 units per kg body weight was thought to be normal.
If you halve your weight in kilograms, in other words, you would get an approximation of what a daily amount of insulin should be. Whatever you need in excess of that must be a measure of your insulin resistance combined perhaps with what could be excess carbohydrate in your diet.
You could regard 92 units as a starting point - a dose necessary to normalise your blood sugar levels to begin with. From there you could begin to address your insulin resistance with a combined approach of increased exercise and reduced carbohydrate.
You should be able to reduce your dose over time if you work at it for sure.

All the best,

fergus

 

[stephenT2]

Yikes, my body weight is 71 Kg, that means I should be on 35 units/day? Or have I picked that up wrong.

If not, am I seriously just crumbling apart

stephen

 

[fergus]

If you weren't diabetic and ate a diet witout excessive carbs, that would be about right, I think.
I suppose it illustrates the effect of insulin resistance. It's definitely something you can make a big impression on with diet and exercise though.
One big advantage of reducing insulin levels is that it makes fat metabolism much more efficient. Weight loss becomes easier and weight gain correspondingly harder.

All the best,

fergus

 

[Katharine]

I agree you seem to be very insulin resistant.

Metformin can often improve this. Are you on it ?

A low carb diet can also reduce the need for insulin needed for meals. Over time it also helps weight loss and reduces the belly fat that tends to make you more insulin resistant. It takes a while but you then also need a lot less basal insulin.

My son sticks to the 7 unit rule. This is a lot of jags in a day. On the other hand there is less pain with each jag and so far no lipoatrophy or hypertrophy.

 

[stephenT2]

Hi Katherine,

Yes, I'm on Metformin as well - 4 x 500Mg/day

(I'm also on Simvistatin, Lipantyl, Niaspan, Aspirin and Ramipril) 18 months ago, I didn't even take a pain killer from one year to the next!!

I've turned into a real 'junkie' and a micro drain on the NHS

I am not overweight, but unfortunately there is a diabetic history in my family, my genes aren't great - I really could've chosen my parents so much better!

Its just depressing at the moment taking so much medication, and not seeing a good end result in my BS meter. I'm going to the diabetic clinic this Thursday, and am going to ask that my Pancreas be tested, just to see exactly if its producing any insulin at all. Just for my own piece of mind.

Thanks for all your continued replies....

Stephen

 

[fergus]

Hi Stephen,

I wholeheartedly believe that a low carb diet will certainly reduce your need for medications. Many have found themselves able to abandon their meds altogether once their diet has been changed.
Could you tell us your lipid levels (cholesterol, LDL, HDL, triglycerides) since I see you are taking statins?

All the best,

fergus

 

[greenmonkey]

I weigh around 62KG and I'm on 35 units of Levemir. The heavier you are, does that mean the more you have to inject?

 

[stephenT2]

Hi Fergus,

My most recent results are:

total cholesterol 4.6 mmols/l
HDL 0.6 mmols/l
triglycerides 4.0 mmols/l
HbA1c 8.8%

What do you think?

stephen

 

[fergus]

Greenmonkey, yes.

Stephen, I'm afraid you are a prime example of why cholesterol numbers are very misleading. If most people were told that their cholesterol level was 4.6mmol/l, they would be pretty pleased. But 4.6 could mean a low, medium or high risk of CHD, depending upon the other numbers. I'm afraid you're leaning towards the wrong end of that scale.
HDL should be above 0.8, and in fact the higher the better as it is protective.
Triglycerides should be as low as possible and 1.7mmol/l is the upper safe level.
Cholesterol ratio is a useful measure of CHD risk and is found by dividing total cholesterol by HDL. Yours, therefore, would be 7.66. Below 4 is the current recommendation.
A non-diabetic HbA1c would on average be between 4.2 4.6%. The closer we can get to that, the lower the risk of long term complications. 7% is currently set by the NHS as the upper safe limit for diabetics. In the US, that recommendation has recently been reduced to 6.5%.
I'm sorry if this seems like bad news, but there is good news too. Every one of these measurements can be improved, and very quickly too, by reducing the carbohydrates in the diet, particularly sugars and starches.
By all means PM me and I'll be glad to explain in more detail.

All the best,

fergus

 

[sky]

A few weeks ago I was changed from tablets, onto injecting long lasting (Levimir) insulin (NovoPen).

To start with I was on 10 units, this was no problem, over and done with in a few seconds, virtually no pain/discomfort. However, I am now up to 60 units, and there is certainly discomfort once I pass the 20 unit mark. Is it better to press the release button very slowly, or should you just press it hard and get it over as quick as possible?

I also get rashes now, with hard patches and my tummy feels like a pin cushion and itches. I change the injection site every time.

Any advice appreciated.....

stephen

"I also get rashes now, with hard patches and my tummy feels like a pin cushion and itches. I change the injection site every time."...my hard patches eased, when i went to the thinnest needle point.