Alternative injection sites?

[Westley]

Does anyone here inject insulin into their upper chest?

I've been trying to give my stomach sites a rest (getting some slight scarring) and experimenting with this for my bolus injections.
So far chest seems okay, fairly fast absorption, and not much pain, though I've only tried a couple of times so far.

I don't really like using arms/shoulders/lower thigh as I don't have much pinchable fat there, and upper thighs/butt are what I use for basal (and also I find absorption slower there).
I never see it suggested in the typical injection site diagrams - is there some reason against using it?
The only reason I can see so far is that there is more hair there, and I think hitting a hair follicle can be painful, though it has been okay so far.
I was also considering calves as another possible option.

 

[noblehead]

Hi @Westley

Like you I've never seen the chest suggested as a place to inject insulin, so for that alone there has to be a reason why.

As for injecting into the calf, you have to be aware that injecting into a muscle means the insulin will work much faster than injecting insulin into the subcutaneous tissue.

 

[azure]

I wouldn't like either of those options. I've used legs, bum, tummy and arms, and the side of my waist.

 

[therower]

@Westley . Never tried injecting into chest to be honest. You mention not being able to use certain sites because of a lack of pinchable fat. Don't know what needles you are using but with 4mm needles you really shouldn't have to pinch fat prior to injecting. Personally I stopped pinching to inject once I switched from the old syringes to an insulin pen, I've never had any problems.
Good luck and I hope you find some new areas to aim for.

 

[GrantGam]

Have a look at the attached image that @himtoo has posted in an older thread, it demonstrates just how big an area their is to inject in the abdomen area. We often seem to think this area is smaller than it really is, and often don't expand outwards from the belly button or use our sides enough.

http://www.diabetes.co.uk/forum/threads/type-1-unexplained-highs.111406/page-2#post-1309282

More important though, and this cannot be stressed enough is good, well planned and executed site rotation. I'd advise you to download and print off the site rotation template from the following link - it's actually really good and allows for a week on each side of your belly. That means a fortnight between site use which is great. You could also add your sides into this rotation plan, which would be even better too!

http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=7282

There is no hard and fast answer to how you should rotate your sites, but here's another guide which gets 4 weeks out of the whole abdomen!

http://www.fit4diabetes.com/files/2613/9533/4732/FIT_TP_Site_Select_HCP.pdf

If your abdominal "scarring" is quite slight, then you may be able to start a new routine in that area, and just take care to avoid any really bumpy bits. Your Dr or DSN will be able to make a good assessment of your injection sites and advise on areas to avoid and means to remedy your issues. I wouldn't go with injecting in your chest, I'm yet to read anywhere or here of anyone using that section of the body. Probably for good reason...

I am aware of injecting into the calf muscle, but it's not suggested by the NHS and is only really a means to bring down really high BG quicker than normal.

 

[Westley]

Thank you all for your replies. I guess I could try and be a bit more systematic in my site rotation - my current technique is just to feel around until I find a spot that feels fresh. 5 regular injections a day plus usually at least a couple more correction doses take their toll though. Also I guess the spots more easily reachable without getting too undressed tend to take a bit more than their share of hits when I'm out and about.
I'm already on the 4mm needles and don't actually pinch up. My mention of 'pinchable' fat is more about the consistency. I'm not ridiculously lean, but what fat I do have in my arms and legs feels like it is more mixed in with the muscle, if that makes sense, and even 4mm causes pain. On my stomach and butt there feels like a more distinct surface layer.

 

[GrantGam]

I'm not ridiculously lean, but what fat I do have in my arms and legs feels like it is more mixed in with the muscle, if that makes sense, and even 4mm causes pain.

I, like you, struggle to inject into my leg - there's not enough fat there for me and I bruise around 80% of the time.

You'd be very surprised just how much fat there is on the rear of your arms though, I tried many times to inject there and always experienced pain until a knowledgeable forum member advised on a better approach:

Stretch the arm you wish to inject into directly out in front (like you're pointing at something), and then come in from underneath with the insulin pen. I find it easiest to hold the pen between my thumb and middle finger and press down on the plunger with my index finger.

I'm sure you'll be surprised how much fat you can feel on the back of your arm when it's at 90 degrees to the floor and relaxed. The upper arm also happens to be the second best site in terms of the absorption rate of insulin. But as it's not as quick as the abdomen - you may want to have a look at the "pre-bolus" technique to help your BG management if this is a site you'll be using for bolus.

 

[Westley]

Thanks @GrantGam - this is a useful suggestion. I haven't tried in my arms for a long time, as the previous times I did resulted in bleeding/going into muscle, but perhaps with a different technique it is worth another try.

 

[emilyj17]

Help! I just injected my basal, and even though I try to rotate, it was quite painful this evening and I noticed a lump when I took the pen out. Does this mean the insulin won't absorb well??

 

[EllsKBells]

Hi @emilyj17 , far too ignorant to know if it means it won't absorb as well, but back in the days when I was on a much larger dose of Levemir (48 units, unsplit) I used to get large lumps after injecting, and I used to rub the area with the heel of my hand, which would normally get it to go down. Hope that helps, and hopefully someone with more knowledge than me will be along soon to answer the question about absorption. Might be worth starting a new thread?

 

[GrantGam]

Help! I just injected my basal, and even though I try to rotate, it was quite painful this evening and I noticed a lump when I took the pen out. Does this mean the insulin won't absorb well??

If it was a small lump about the size of a pea, then it was probably caused by the needle not going deep enough. The insulin kind of gets trapped under the skin. When this happens, the lump tends to disappear after a few hours and the insulin gets absorbed normally.

It's good to keep a closer eye on your BG following an incident like that.

Was that the case with you @emilyj17?

 

[emilyj17]

@GrantGam It seem's to have been fine and bump disappeared fairly quickly! I had actually dropped to 3.8 on waking up at 7 and have been as normal so far today