Basal Injection Site Issue...

[GrantGam]

Hi guys!

Having a bit of an issue with injecting Levemir into my thighs. The long and short of it is that every time - without fail - I'm left with lumps and bruises at the injection site, I'm injecting 9u at a time with 4mm, 32G needles.

I don't have a great deal of fat on my legs but I'm finding that it makes no difference whether I "pinch an inch" or just put the needle straight in...

Because of this, my basal insulin is limited to the top of my buttocks where I'm also noticing some lumps. I'm confident that it's not a fat build up caused by overusing the areas as I think I've got decent site rotation in place. As I've only been diabetic for 2.5 years, I'm starting to wonder is this some sort of reaction to the insulin or another issue altogether?

Look forward to your thoughts and thanks in advance

Grant

 

[noblehead]

Unusual given the time that you've had diabetes, it may well be an allergic reaction to the insulin, do you get these lumps with your bolus doses?

 

[GrantGam]

Unusual given the time that you've had diabetes, it may well be an allergic reaction to the insulin, do you get these lumps with your bolus doses?

Thanks for the quick response, @noblehead. My body seems fine with the Novorapid, although I've only ever injected that into my abdomen - never tried my legs or bum.

I wonder if it's worth trying the Levemir in my abdomen for a few days to see whether I get lumps and/or bruising there too? I've always wanted to reserve my abdomen strictly for bolus; as if I were to get lipo issues, I'd imagine it would likely start there...

 

[noblehead]

You could also use your arms Grant.

Over the years I've seen many people say they've had allergic reactions to certain types of insulins, as there's other options available it's worth discussing with your team if a change is possible, if I were going back to MDI I'd ask for Tresiba.

 

[GrantGam]

You could also use your arms Grant.

Over the years I've seen many people say they've had allergic reactions to certain types of insulins, as there's other options available it's worth discussing with your team if a change is possible, if I were going back to MDI I'd ask for Tresiba.

The arms are somewhere I've only tried once or twice, but should definitely give it a go - again that'll help with my site rotations.

I'll bring up my basal issues at my next appt. Hopefully we may have made some progress with my pump referral, I'm currently waiting on a meet with the head of pump therapy for my region So fingers crossed basal insulin need not be an issue in the near future!

Tresiba would be my 'go to' basal insulin if possible. I see that NHS Scotland have recently started prescribing it, so here's hoping that they may consider that with me - should they find that I'm in some way allergic to Levemir.

Thanks for your input @noblehead, sound advice as always!

 

[robert72]

hi @GrantGam1337

I had the same problem when I tried Levemir a few years back. Large red lumps at the injection site probably around 4cm across, which took several days to disappear. My Dr said it looked like a local reaction. I changed back to Lantus and all was OK (am now on Tresiba). I've been T1 for nearly 45 years and never had reaction to any of the other insulins I've used over that time, so hopefully a switch of basal will work for you.

 

[novorapidboi26]

Do they lumps go away eventually.....

It may just be a collection of some of the insulin near the surface...which is just one of these things with injecting...

 

[steve_p6]

Grant have you tried 6mm needles as an alternative?

 

[GrantGam]

hi @GrantGam1337

I had the same problem when I tried Levemir a few years back. Large red lumps at the injection site probably around 4cm across, which took several days to disappear. My Dr said it looked like a local reaction. I changed back to Lantus and all was OK (am now on Tresiba). I've been T1 for nearly 45 years and never had reaction to any of the other insulins I've used over that time, so hopefully a switch of basal will work for you.

Hello @robert72.

I'm not getting the redness that you describe, but I am getting bruises around the same size and lumps which take a few weeks to disappear... It's a bit of a pain.

I'm hoping to change to Tresiba providing that I am unsuccessful with my pursuit of an insulin pump. From what I've read (both online and with your posts) it seems like it's actually a 'true' basal insulin.

Thanks

 

[GrantGam]

Do they lumps go away eventually.....

It may just be a collection of some of the insulin near the surface...which is just one of these things with injecting...

The lumps do go away, but only after a period of weeks. I've had a few instances before where insulin has collected under the skin (bolus dose in abdomen, needle not fully in) - but these left lumps about the size of a pea that vanished in a few hours...

 

[GrantGam]

Grant have you tried 6mm needles as an alternative?

Hi @steve_p6,

I've never tried longer needles. To be perfectly honest though, I think 4mm is more than long enough for me. I'm not a big guy, 69kg and 5' 8" - and really don't carry much fat on the front of my thighs.

I know it might sound daft, but maybe 4mm needles are too long for my thighs? It's all too regular that I'll get a little bleeding from the injection site on my thigh, vs that of anywhere else on my body. Going by what I see on the photo in the below link; that would be indicative of the needle going too deep?

Surely 4mm can't be too long though...?

http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=7264

 

[steve_p6]

Hi @GrantGam1337

I've never tried longer needles. To be perfectly honest though, I think 4mm is more than long enough for me. I'm not a big guy, 69kg and 5' 8" - and really don't carry much fat on the front of my thighs.

Hi @GrantGam1337 No science behind my thinking other than maybe a bit deeper might help. I have used 6mm and used to do 26u of Levemir per shot, also used to shove it in shoulder/belly as alternatives never had any issues with muscle either with modern needles. But what works for one does not necessarily work for all.

 

[GrantGam]

Hi @GrantGam1337 No science behind my thinking other than maybe a bit deeper might help. I have used 6mm and used to do 26u of Levemir per shot, also used to shove it in shoulder/belly as alternatives never had any issues with muscle either with modern needles. But what works for one does not necessarily work for all.

Thanks Steve, I'll bring up needle length at my next Clinic visit and see what they reckon. They'll get a look at my sites too and hopefully shed some light.

Thanks for taking the time to get back to me!

 

[noblehead]

I've never tried longer needles. To be perfectly honest though, I think 4mm is more than long enough for me. I'm not a big guy, 69kg and 5' 8" - and really don't carry much fat on the front of my thighs.

4mm should work just fine, according to the following article most people have a skin thickness of less than 2.8mm so a 4mm needle will hit the subcutaneous tissue:

http://www.diabetesforecast.org/201...sulin.html?referrer=https://www.google.co.uk/

 

[GrantGam]

You could also use your arms Grant.

Last night I put my basal into my abdomen and this morning, into my arm.

There was no bruising or lumps in either location so I think that the issues with my legs must be down to the lack of fat there...

By the way, I applied your arm injection technique that I'd read in another thread (arm to be injected in the air and bring the pen in from the underside with the other arm) and it worked a treat! It was a lot better than the methods I'd tried before so thanks very much

 

[noblehead]

Good stuff Grant, at least your finding a solution to the problem

 

[GrantGam]

Good stuff Grant, at least your finding a solution to the problem

Pending the outcome of my insulin pump pursuit; I'll also be requesting a change to Tresiba if it's a possibility at my clinic. But fingers crossed basal insulin will be a thing of the past sometime in 2017

 

[Daibell]

Hi. I use Levemir in the thigh without problems. I think you need to change your Basal insulin perhaps to Tresiba?

 

[GrantGam]

Hi. I use Levemir in the thigh without problems. I think you need to change your Basal insulin perhaps to Tresiba?

Hi @Daibell

It's something I'll be bringing up at my next clinic appt. Levemir has given me some lumps on my bum and lumps on my thighs/bruising. I really don't know why this is happening, if it's a reaction, or if the needle is just going too deep (thighs only, plenty fat in the other area).

I think I'll keep up with the arm injections, and if I notice any frequent lumps or bruising there - then I can probably assume that my body isn't agreeing with Levemir.

Although I've only done one basal injection into my arm and one into my abdomen, there's no lumps or bruising at all...

EDIT - after a glance at the possible side effects of Levemir, I seem to fit a good few of them... Joint pain, aching, bruising at site (legs only), lumps (bum and legs) and general tiredness. Now you have me thinking... Will just have to see how things go for the next few weeks and take it from there. You've made me re-think things @Daibell, thanks

 

[wileykit55]

Hi,
The lumps could be due to poor absorbtion. Try injecting slowly - like 2units wait a few seconds then another 2 units etc... could be that 9u is too much to be absorbed all at once, especially if only using 4mm needles. Either that or try 6mm and see if that helps.