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Basal problems

annapanna93

Well-Known Member
Messages
54
Location
Lancashire
Type of diabetes
Type 1
Treatment type
Insulin
Hello,

I've recently tried taking my lantus in my leg instead of my stomach because of the lumps it creates under my skin (no idea why it does this) - however since then I have found my blood sugars are pretty consistently high even when I've taken a lot of Apidra.

Is it better to keep my lantus in my stomach? Or is the cause of these hypers something else all together?!

Any help would be massively appreciated.

Anna x
 
It might be an idea to talk to your DSN about the lumps. Have you tried a basal test using the legs?
 
I've never been able to inject in my thighs (I'm very scrawny and have no fat there).
I inject Basal in my butt cheeks and bolus in my stomach.
 
Insulin absorption is usually slower in the thighs than the stomach area so that might be why you're seeing a rise, which may or not affect the amount you need to take.
 
I was told never again to inject in my stomach due to overuse of a couple of areas. I think it is underestimated how difficult it is to remember and monitor use of different sites. I was advised to inject basal at the top of each buttock - that's not an easy place to reach, but I do. For bolus insulin I alternate between hips, but there isn't a lot of fat there, so I use a short needle carefully. Yes, it might be a good idea to have a discussion with your DSN as to whether you have caused lumps (which is what I had done) and that therefore your insulin injections are not getting utilised effectively.
 
Hi @annapanna93,

I personally feel it's good idea to take your lantus in the leg; most long-acting insulins don't actually last a full 24 hours (it may be around 16 hours for some people); insulin injected via the leg will take longer to absorb than abdominally, which is what we want. Also, do you split your lantus, or do you take it just once a day?

Also - sounds silly, but have you checked whether your lantus pen is damaged? This happened to me recently with my fast-acting insulin (Novorapid) - sugars just kept rising, no matter how much I corrected. I soon discovered a tiny hair-line crack in the clear plastic reservoir, which meant the insulin wasn't dispensing properly - I'm quite accident prone, so probably dropped it and thought nothing of it - might be worth just checking this before you change anything!x
 


I usually take 1 dose of 18 units every morning. Did you find you needed to increase your dosage in your leg?
 
annapanna93 said:
I usually take 1 dose of 18 units every morning. Did you find you needed to increase your dosage in your leg?
Click to expand...

I've always injected my long-acting insulin in the leg, so I can't compare it to any other sites - however, from what you say, your blood sugars have been higher after you made the change from stomach to leg; this suggests to me that:

(1) the lantus is (as would be expected) is taking longer to absorb, so it will be in your system for longer; but also that -

(2) the concentration of lantus in your system over any given period will be lower - in other words, there's less "active" lantus working in any given 1 hour period (as it's being stretched out over a longer total time) - which probably explains why your sugars have been higher, and you may been needing more fast-acting insulin for meals.

To confirm this, it would interesting to see what's happening to your sugars at night and on waking - when you were taking the lantus into the abdominal area, did you notice your sugars were higher at night and in the morning? In theory, now you're taking lantus into the leg, it may be that your sugars are lower at night/in the morning - have you noticed any change?
 
Depending on how you have been injecting in your stomach you may have something called Lipohypertrophy. The article below explains it quite well.

https://www.healthline.com/health/diabetes/lipohypertrophy

Basically if you have these lumps, your full insulin dose may not be absorbed by your body. It is useful to keep rotating your sites. Injecting in your bum is a wee bit awkward but is also a great place to inject
 
I don't use my legs at all as I found very early on that the absorption rate was so erratic (and mostly slow) that it was just unreliable. If you've used your legs a lot (doesn't sound like it?) @smc4761's quite right, lipohypertrophy can be an issue. I now have to avoid areas of my abdomen because of it, but I have been injecting for 33 years....
 

Often during the night when my lantus was in my stomach, I would go into hypo. Since trying in my leg, it hasn't really happened so that's a plus. I upped my dosage today, I injected 22 units in my leg and that seems to be working okay. But then I got a lump under the skin when I injected, and that's what I was trying to avoid, so that's a bit of a bummer.
 

Sounds as though injecting into the leg is giving you a "flatter" absorption profile, which is good. When you say you get a lump under the skin, does the lump form immediately after taking the injection? If so, it's very likely that either:

- you're not injecting deeply enough - or

- you're pulling the needle out too soon (whilst the insulin is still dispensing)

In both cases, this will lead to the insulin (or some of it) actually collecting under the skin, rather than completely absorbing into the fatty tissue (this can happen abdominally too, or anywhere else). Many people pull out too soon, without realising that the insulin is actually still dispensing for quite a while after they have pressed the plunger down.

If that's the case, it might be best to rectify the depth of injection/time of withdrawal before altering the dosage (otherwise the 22 units may be a little too much if it's all absorbed into the fatty tissue). What length needles do you use?
 

Insulin tends to absorb quicker into system when injected into stomach thats why legs or bum are probably best.

Ideally you should be using a needle 4mm-6mm. As Odin has advised above, once you have pushed the plunger all way down wait for at least 5 seconds before slowly removing the needle
 
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