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Changing long acting insulin injection sites

S

SamD27

Newbie
Messages
3
Type of diabetes
Type 1
Treatment type
Insulin
Hi,

I am in desperate need of some advice, after a longgg time of wanting to switch my long acting insulin injection site for more flexibility and better control (has always been in the stomach as this is what I was told to do when I was diagnosed 6 years ago.)

I have started to inject into my leg over the last 5-6 days and in the past I have tried this a couple of times with the same results, that being a complete loss of blood sugar control.

My wife and I went out for a meal on Sunday 26th and I was already running around 9-10, so I injected into my stomach for my meal and took additional in the hopes of coming back into range afterwards (approx 17? For what was around maybe 120g of carbs) but remained high all night afterwards so in total over the course of the night I took an additional 18 units before bed to no effect.

Monday the 27th I didn’t have too much to eat during the day, however it kept creeping closer and closer to being out of range and again as expected after having my dinner, it jumped to around 12 and remained there all through the night even after taking another 6 units before bed again.

Having spoken to the diabetic team at the hospital multiple times over the years about wanting to swap the injection sites only to be told ‘just do it, it will be fine’ every time has been met with the same results and having to change back.

I am on:

Novorapid 1:10g
Lantus 34 units (increased by 1 from 33 since initially swapping the injection site in the hopes of fixing the issue)

Apologies for the very long post and thanks in advance.
 
The problem with not changing insulin injection sites is that you can get lumps in your injection sites which in turn results in poor absorption of insulin , this can result in inconsistent control . As a rule I swi my sites daily I use four on a rota legs and tum , plus I don’t inject in same spot , on the same leg or tum this gives you more than enough areas within a month to prevent lumps and the resultant poor absorption. Personally I was having problems with Lanctus ! My consultant class Lanctus as being inconsistent , so I was changed to Levimir twice daily , my control is now much better , this is just a personal experience , but changing injection sites will definitely help
 
I use bottom for basal, swapping butt cheeks weekly. Stomach for breakfast when my insulin resistance is at its highest. Swapping sides weekly. Legs also swapping weekly are used for other food.
Was on a Daphne course years ago with someone who always injected in the same area. They were so worried about her absorption rates by changing areas that they slashed her basal amounts to ensure she didn’t have a massive hypo. That is why it is imperative to rotate areas regularly and I feel your team have been very remiss in not getting you to do this. Choose another area and work again at getting the balance correct. It may take a bit of trial and error but be worth it in the end.
 
Are you sure the change of sites is the cause of your high?
Is it possible that there is something wrong with your long acting insulin or pen?
Whilst some areas work faster than others, I would not expect a major change in your insulin dose when you change sites.
 
Thank you for the responses,

To reply/clarify

Both long acting and rapid insulin pens both appear clear and had been adequately refrigerated until taking out for use.

Regarding injection sites I would depending on the time of day either use stomach, arm or leg and for example such as the case now I will pick one side of my stomach to inject into for a couple of days, working my way across the site each time I needed an injection and always careful never to inject into a previous site before switching over to the other side of my stomach for a few days following the same pattern (same for arm and leg.)

And currently no hard lumps have formed in the areas I use for injections.

Thank you for the replies
 
SamD27 said:
Both long acting and rapid insulin pens both appear clear and had been adequately refrigerated until taking out for use.
Click to expand...
Even if they looked ok and I had stored them correctly, I would still change the long acting one if it appeared not to be working to rule that out.
 
In Response said:
Even if they looked ok and I had stored them correctly, I would still change the long acting one if it appeared not to be working to rule that out.
Click to expand...
I have just binned the one I was using and replaced it with a new one so see if anything changes, the most annoying thing is with Lantus is any kind of change e.g dosage takes 2-3 days before you notice any changes.
 
SamD27 said:
the most annoying thing is with Lantus is any kind of change e.g dosage takes 2-3 days before you notice any changes.
Click to expand...
This is not my experience. Lantus tends to last less than 24 hours.
Until I changed to a pump, I would change my Lantus dose almost daily based on how much exercise I had done. This allowed me to avoid hypos after intensive exercise.
 
We're all different, but have you tried injecting your Lantus into a totally different part of your body? The reason I ask, is that insulin has never worked well in my legs.
 
I have recently had a long discussion with a dr.about injecting sites in general, and insulin/diabetes in particular…different sites can produce very different results in absorption whether at most extreme the injection goes into a blood vessel so all ‘drug’ quickly taken around the body/ gets into organs, or via sub cutaneous fat, a much slower route with smaller amounts being absorbed over longer period of time. Sounds like a self experiment is coming on to see if the same quantity of Fiasp behaves differently injected at different sites, assuming exactly the same meal, exercise etc etc. I presume with slower Toujeo there would not be same effect anyway.
 
@SamD27 I've had T1 for nearly 40 years. I not longer inject in my stomach as repeated injections early on - without adequate advice on changing injection sites - mean I now have hyperlypotrophy. This was not obvious to me and was diagnosed by an expert diabetes nurse; I still can't feel the lumps but my absorption is definitely affected. I've therefore injected all over my trunk excluding that area; anywhere there's enough fat to pinch is okay for injecting. I too find absorption in my legs slightly erratic, but better these days than when I tried initially. I also use Lantus and find it works much better for me by splitting the dose in two and taking half in the morning and the other half 12 hours later. You should also have been told not to use the same sites/areas for injecting basal and bolus. I therefore use my trunk - and occasionally arms - for bolus and, like @becca59 I use my bum for basal. My system is different in that I work across one cheek in horizontal lines (very roughly as I can't see what I'm doing) and when I've moved from the bottom on one cheek to the top I then change to the other and repeat the process on a rolling basis. This is working well for me, but as with everything else with T1 we're all different.
Just one question - when you say you inject additional insulin to bring down highs, I assume you mean Novorapid? Personally I don't consume 120g carbs in a day, let alone in one meal, as I find it easier to stay in range by eating fewer carbs and therefore needing less bolus. Hope you find a way to resolve your problme.
 
SamD27 said:
Hi,

I am in desperate need of some advice, after a longgg time of wanting to switch my long acting insulin injection site for more flexibility and better control (has always been in the stomach as this is what I was told to do when I was diagnosed 6 years ago.)

I have started to inject into my leg over the last 5-6 days and in the past I have tried this a couple of times with the same results, that being a complete loss of blood sugar control.

My wife and I went out for a meal on Sunday 26th and I was already running around 9-10, so I injected into my stomach for my meal and took additional in the hopes of coming back into range afterwards (approx 17? For what was around maybe 120g of carbs) but remained high all night afterwards so in total over the course of the night I took an additional 18 units before bed to no effect.

Monday the 27th I didn’t have too much to eat during the day, however it kept creeping closer and closer to being out of range and again as expected after having my dinner, it jumped to around 12 and remained there all through the night even after taking another 6 units before bed again.

Having spoken to the diabetic team at the hospital multiple times over the years about wanting to swap the injection sites only to be told ‘just do it, it will be fine’ every time has been met with the same results and having to change back.

I am on:

Novorapid 1:10g
Lantus 34 units (increased by 1 from 33 since initially swapping the injection site in the hopes of fixing the issue)

Apologies for the very long post and thanks in advance.
Click to expand...
I use backside for basal, stomach and top of legs for bolus. Injecting into muscle will speed up the action of the insulin, in my case if injecting my basal (insulatard) into my legs it would kick in within an hour and be done by 6hrs in. Spoke to clinic and they advised backside, doses have dropped to 36u on a night and 14 on a morning using backside. Inject twice a day in stomach of bolus(humilin s) 22u in morning and 22 at night, slower acting than fiasp,etc and lasts 8hrs.
 
TerriH said:
Do you have a diabetic specialist nurse? Do you have an annual diabetic review or clinic you can go to? If so they should check for lumps etc. If not, as is too often the case, then here are a few things I have learnt over the years. I take 3 injections of NovoRapid daily one before each meal and one of Tresiba each evening before the evening meal. Many things can affect the insulin hot or cold weather, activity you do or don`t and I use my stomach alternating sides every time I inject. The site needs to be where there is more flesh so I don`t inject into my arms for example.. I also take less insulin if I know that I am going to do gardening, cleaning for example and more insulin if I am going to be sitting down for most of the time. What you eat in the amount of carbs. in particular also has a big effect. There are various courses you can use either in person or online Daphne for instance and Pocket Medic also has a lot of very useful advice. In Wales we have "the Orange Book" which you can get at www.xpertheallth.org.uk written by Dr. Trudi Deakin and there are also books etc from Diabetes UK which may help.
Good Luck!!!
Click to expand...
 
@TerriH does your DSN actually check your injection sites?
My clinic's idea of checks is to ask "Are your sites ok?"
I am sure this ticks the box but I would not assume that an annual diabetes review will really check for lumps.

I have enough sense to keep an eye on it and change my sites regularly.
 
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