Injection Sites Question

[Emck]

Hi All,

Hope everyone is keeping safe and well!

I had a question to any longer-term diabetics/DAFNE followers (i.e. those that have probably injected 10s of thousands of times ).

I have recently been finding it harder and harder to find successful sites. For context, I have been diagnosed for 22 years and follow DAFNE. I am generally looking at a minimum of 5 injections a day (2 basal and mealtime boluses.

I keep finding that my injections aren't absorbing as well as they should. I rotate my site every time mostly between abdomen and bum (for basal as my doses are higher 42 night and 22 morning and this is the only area that tolerates such high amounts).

I have had to stop using my legs and parts of my lower abdomen as they just end up covered in lumps.I also end up with huge bruises and sites that leak post injection. I think this is due to overuse in my teens and 20s and the fact that my legs are quite muscular so don't really work for larger doses.

I find my arms very sore to inject and again, they bruise badly. My DSN says that they don't really recommend it as a site anymore.

I have taken to using my sides and above belly button , but I'm just finding injecting such a chore now. It is really painful and I just feel like I'm running out of places to inject! I'm constantly bruised and lumpy and never really confident that my sites are effective.

Does anyone have any recommendations for alternative sites or does anyone have suggestions for healing sites that are a bit over-used??

Thanks in advance and apologies for the rant.

 

[Daibell]

Hi. Those injection figures are quite high? Can you let us know whether you have some excess weight and if so that may have caused some insulin resistance. I assume you are keeping the carbs down so you don't need to inject so much?

 

[ert]

Hi. Those injection figures are quite high? Can you let us know whether you have some excess weight and if so that may have caused some insulin resistance. I assume you are keeping the carbs down so you don't need to inject so much?

The higher doses could be her age and due to hormone levels.

 

[Emck]

I have some really unexplained insulin resistance. My diabetes team don’t know what causes it. I have tried taking metformin but it doesn’t do much.

They just put it down to my own genetics. I have a little excess weight at the moment, but not so much as to cause insulin resistance. Everyone is different and needs a different amount of insulin!!

I take the amount that I take because I need it! My ratios are pretty normal. It’s just the basal that is a large dose.

 

[UK T1]

Hi,
Have you asked your diabetes team about this again recently? I'm no doctor but I wonder whether a different needle size would help? Also making sure you're leaving the needle in a little longer after you've finished injecting? I think the advice is 10 seconds but perhaps even longer would help for larger doses? And of course a new needle every time. Sorry if this is obvious!

Also perhaps injecting large doses in 2 lots in 2 different places? Sorry I realise that means more injections but it might mean smaller 'lumps'? Say split the basal, inject it at the same time same total dose but eg 11 units on the right side and 11 on the left side rather than 22 all together?

I notice a big difference in how quickly doses break down, and so are absorbed, according to my activity, so even gentle exercise will make me much more sensitive and break down what I've injected faster. My largest dose is 11units so I appreciate it is different from yours, but I notice an initial lump when I've just injected. This then disappears faster if I've been more active the days surrounding that injection. Similarly gentle massaging over the area the day after I've injected has helped in the past when I've had some lazy days and been less active!

Sorry if this seems obvious, I don't mean to patronise! Hope your diabetes team can help too. I saw this which might help https://twitter.com/LDC_tweets/status/1260558388531998720?s=19

Re sites- different sites have different absorption speeds and I believe this is in part why they don't recommend arms anymore. I am also often surprised how large an area there is to inject in, forgetting you can go quite wide and high on the abdomen for example, also lower back just above the buttocks too. It is easy to slip into habits then realise I'm not rotating sites as much as I could be.


Hope some of my rambling helps a little at least!

 

[Bishop]

Hello
To avoid lumps you also need to consider the length of the needle and to split the dose in the case it is larger than 10 units.
I have made a video about it.

You can find many other useful videos on my channel.

 

[Rokaab]

To avoid lumps you also need to consider the length of the needle and to split the dose in the case it is larger than 10 units.

I have never been told to split if its above 10 units, that would mean a lot more injections for some people as well, whilst I'm now slightly lower carb, a year ago that would've meant 2 injections at every meal and my basal as well - no thanks I've already had 55k+ injections in my life so far, lets not double the daily amount

 

[becca59]

@Rokaab many of us already inject more often to maintain more level numbers. I myself wouldn’t think twice about 3 injections for a meal. Often have to have one in the early hours to combat DP and 3 injections around breakfast to stop rises in the morning. Even though carbs in the morning are virtually non existent and pretty low throughout the day.

 

[Fairygodmother]

It’s certainly a lot of basal. I’m not being judgemental, we’re all different and there’s no one size fits all in this game.
How long have you been using that particular basal? I only ask because of my own experience with Lantus: it ceased to be as effective after a few years. I really don’t know why, but maybe I’d begun to recognise it as an invader and my T cells had started to eliminate it. Only a guess. The problem disappeared when I began using Levemir.
Have your team suggested any alternatives?

 

[Seacrow]

I've already had 55k+ injections in my life so far, lets not double the daily amount

Heh. At one point I was on 50+ injections PER DAY. I too have extreme insulin resistance for no detectable reason.

So, injecting anywhere that is bruised, lumpy or within the red area caused by a previous injection can cause your insulin to work badly. By badly I mean extra slowly, extra rapidly, at half strength, double strength, losing the tail end of the activity profile etc. Not a good idea, but it's totally understandable that sometimes you find the best available site and just go with it. Unfortunately the best way to heal the sites is to stop using them. It took me about 18 months before all my lumpy bits had really gone.

From this you may gather I found a solution that worked for me - the pump. Effectively one needle insertion per two days with very slow continuous fluid injection. I still find the insertion site reacts, forms a very small firm lump, but once every two days is manageable.

Perhaps you could ask your dsn if your doctor is likely to agree to a pump to 'improve your quality of life' (that was the reasoning behind my pump to begin with)? With such a large difference between night and day basal doses it might be helpful to be able to split your basal into more segments as well.

 

[Bishop]

I have never been told to split if its above 10 units, that would mean a lot more injections for some people as well, whilst I'm now slightly lower carb, a year ago that would've meant 2 injections at every meal and my basal as well - no thanks I've already had 55k+ injections in my life so far, lets not double the daily amount

Splitting large dosages help a lot with the insulin absorption and should give better control of your BS. This is something I actually realized. You are free to do whatever works better for you but the ultimate goal is to have as good control as possible, I don't mind taking another injection I got used to them. Pricking my fingers on the other hand.....

 

[Emck]

It’s certainly a lot of basal. I’m not being judgemental, we’re all different and there’s no one size fits all in this game.
How long have you been using that particular basal? I only ask because of my own experience with Lantus: it ceased to be as effective after a few years. I really don’t know why, but maybe I’d begun to recognise it as an invader and my T cells had started to eliminate it. Only a guess. The problem disappeared when I began using Levemir.
Have your team suggested any alternatives?

I moved from Lantus to Levemir maybe 1.5 years ago? It has given me much better control but the amount I need is much more than my lantus dose. I was on about 40u for the whole day on Lantus, but was having nighttime hypos and big morning spikes, so levemir allowed me to split this and control the sugars much better.

 

[Emck]

I feel your pain (literally).

I’m on the waiting list for a pump, but the trust I live in is really over-subscribed so it takes years. I presume that COVID will also have slowed this down.

Heh. At one point I was on 50+ injections PER DAY. I too have extreme insulin resistance for no detectable reason.

So, injecting anywhere that is bruised, lumpy or within the red area caused by a previous injection can cause your insulin to work badly. By badly I mean extra slowly, extra rapidly, at half strength, double strength, losing the tail end of the activity profile etc. Not a good idea, but it's totally understandable that sometimes you find the best available site and just go with it. Unfortunately the best way to heal the sites is to stop using them. It took me about 18 months before all my lumpy bits had really gone.

From this you may gather I found a solution that worked for me - the pump. Effectively one needle insertion per two days with very slow continuous fluid injection. I still find the insertion site reacts, forms a very small firm lump, but once every two days is manageable.

Perhaps you could ask your dsn if your doctor is likely to agree to a pump to 'improve your quality of life' (that was the reasoning behind my pump to begin with)? With such a large difference between night and day basal doses it might be helpful to be able to split your basal into more segments as well.

 

[Emck]

Hello
To avoid lumps you also need to consider the length of the needle and to split the dose in the case it is larger than 10 units.
I have made a video about it.

You can find many other useful videos on my channel.

I can’t seem to get the video to play for some reason.

 

[LWA]

Fairygodmother has made a valid point. I was on levimir for many years until I ended up needing more and more. Eventually I just knew my body wasn’t responding to it well enough to continue so switched to Tresiba. Wish I had earlier as now take significantly less and have much better control. (For me It works better if I split dose.