Did I accidentally inject Lantus into a vein

[broccoliSK]

Hi everyone.

So yesterday a weird thing happened. I measured my BG before going to bed (6.2 mmol), injected myself with 9 units of lantus, had a little snack (a slice of bread) and wanted to go to bed. However, rougly 30 minutes later I felt that something was wrong and when I measured my BG it was 2.4. I had read about people accidentally injecting insulin into a vein and then getting the effects immediately as opposed to a slower release.

I then gulped tons of sugar water and my BG rose to roughly 8.5 during the next 20-30 minutes, stayed there for a while and then eventually settled on a whopping 16 a few hours later (I got up in the middle of the night to test and I obviously overdid it with the sugar).

Needless to say I'm quite shaken as this has been my biggest fear - injecting into a vein and than having my BG fall rapidly to dangerous levels.

So my question is - based on what I describe here, do you think I really injected Lantus into a vein? I inject into my stomach area as it is accessible and has more fat than my things. Has anything similar ever happened to anyone else here? And lastly is there a way to decrease the possibility something like this is going to happen?

 

[diamondnostril]

Hi @broccoliSK . . .

The following threads may be worth reading:
http://www.diabetes.co.uk/forum/threads/lantus-followed-by-2-9-hypo.95565/
http://www.diabetes.co.uk/forum/threads/lantus-users.67760/

Lantus Insulin is designed to work by forming tiny crystals after hitting subcutaneous fat - these crystals then dissolve at a uniform rate to provide the 'basal' insulin release. If you don't hit that subcutaneous fat, then it may be that some or all of the Insulin is active immediately rather than crystalized and released slowly.

I think this can happen in several different ways - hitting a blood vessel, hitting muscle, or hitting tissue damaged by previous injections.

My problems with Lantus came when I was injecting into my abdomen, like you are.

I switched to injecting in my thighs, where there was less damaged tissue. I also switched my Lantus injections to the mornings instead of before bed - I figured that if something does go wrong then I prefer to be awake to notice and deal with it. I also became much more scrupulous regarding taking a big pinch of genuine fatty tissue, and rotating injection sites. I haven't had any similar issues with Lantus since making these changes 3 years ago.

Hope it's helpful
Antony

 

[JackpOb]

I haven't noticed any drastic changes in my sugar levels, but sometimes when I inject the lantus into my stomach, it can really hurt, and feel like I'm being pinched quite hard for about ten minutes. Rather annoying!

 

[broccoliSK]

@diamondnostril thank you for the links. I'm relieved to see I'm not the only one experiencing this. I plan on getting in touch with my doctor and mentioning this during my next visit. I'm going to have to be more careful in the meantime.

On a side note - is there a way to tell if there's damaged tissue on my stomach? Because visually everything seems to be OK.

@JackpOb I know what you mean, I scratch myself sometimes as I'm pulling out the needle and it's quite sore afterwards.

 

[therower]

Hi @broccoliSK . I've never experienced anything like this myself but I have on a few occasions injected my bolus ( novorapid ) by mistake. This obviously caused an immediate drop in blood sugar. I've always realised my mistake and been able to get back on track. Not sure what your insulin regime is but could you have possibly made a similar mistake?

 

[broccoliSK]

Hi @therower . Not saying it's impossible for me to make such a mistake but this time it wasn't it. I'm sure because the pens I use for Lantus and Humalog are visually very different and I store them in different places. I'm 100% sure I injected Lantus. Injecting bolus insulin instead of basal is also something I'm trying my best to avoid.

 

[JackpOb]

It's strange because it only feels that way with the lantus, the nova rapid is fine always

 

[himtoo]

Hi @broccoliSK
the links that @diamondnostril kindly provided are something I have experienced when on lantus.
( only a few times in 18 years -- but it did freak me out while it was happening )

I would talk to your DSN if it concerns you a lot and see if you can change background insulin.

 

[therower]

Hi @therower . Not saying it's impossible for me to make such a mistake but this time it wasn't it. I'm sure because the pens I use for Lantus and Humalog are visually very different and I store them in different places. I'm 100% sure I injected Lantus. Injecting bolus insulin instead of basal is also something I'm trying my best to avoid.

Yes I guessed as much but I just thought I'd ask. Hoping that there was someone else out there as daft as me.
Only other thing to offer is , it's maybe just one of those diabetic occurrences that you just can't explain, and I think we've all had them.

 

[broccoliSK]

hypoing for 4 hours sounds really eh... fun. It's good to see that you can laugh about it I'll be sure to mention this to my doctor and hopefully she'll give me advice on how to deal with it

 

[therower]

When I was on Lantus, I injected into my bum and this happened to me twice! It's awful and made me paranoid afterwards. I hypo'd for 4 solid hours. Up and down like a *****'s drawers

@mahola. Thanks for the smile on my face at the moment. You paint a lovely picture.

 

[diamondnostril]

@diamondnostril thank you for the links. I'm relieved to see I'm not the only one experiencing this. I plan on getting in touch with my doctor and mentioning this during my next visit. I'm going to have to be more careful in the meantime.

On a side note - is there a way to tell if there's damaged tissue on my stomach? Because visually everything seems to be OK.

@JackpOb I know what you mean, I scratch myself sometimes as I'm pulling out the needle and it's quite sore afterwards.

Hi . . .

Glad you found it useful . . . some forum members who experienced this problem switched to a different basal insulin - different insulins have different methods of action, and (I think) Lantus is the only one that works via this crystalization when hitting subcutaneous fat. I stayed with Lantus because, when it works correctly, it really works well for me. I really take care now to make sure I get the injections right.

Others may correct me, but I think the damaged tissue due to injections is pretty obvious whenever it occurs . . . lipohypertrophy is the official name, the lumps that form under the skin when the same injection site is used too much. I think if it happens then you can feel it.

Antony

 

[Steve14]

I do this all the time and been having hypos everyday for the past one year. I often inject into the veins in my belly, but nobody told me I shouldn't?!? Belly is the most reasonable place for me because it's full of fat, but still blood gushes out all the time. And another curse (or blessing) is that my thighs are genetically lean and muscular with not even a pinch of fat. When I try to inject there, I get moderate-severe numbing muscle pain and have to stop. So how does one not inject into the vein? How can you tell where to locate the vein-free spots on a fatty area?

 

[tim2000s]

@Steve14 and @broccoliSK I'd strongly recommend that you raise an MHRA yellow card on this behaviour of Lantus. Based on my experience I consider it to be deadly in the wrong circumstance. I wrote about it here. I also had issues (a few years ago now). If you are considering changing, then you will need to avoid both Basaglar and Toujeo, which both work in the same way as Lantus does.

 

[Steve14]

@Steve14 and @broccoliSK I'd strongly recommend that you raise an MHRA yellow card on this behaviour of Lantus. Based on my experience I consider it to be deadly in the wrong circumstance. I wrote about it here. I also had issues (a few years ago now). If you are considering changing, then you will need to avoid both Basaglar and Toujeo, which both work in the same way as Lantus does.

Hi! Thanks for mentioning this. I don't know what Lantus is. We use Insuman rapid and Insuman basal in my country. The article is spot on with the acidity. Sometimes it burns like hell. And it's not the long acting, but the fast acting insulin that gives me trouble. It's unpredictable and produces mixed results. Are you trying to say that you can have stable levels with diabetes on a daily basis with another form of insulin? Because I lost my marriage to the fear of hypos and will never get her back. Sorry I didn't meant to hijack this thread.

 

[tim2000s]

Hi! Thanks for mentioning this. I don't know what Lantus is. We use Insuman rapid and Insuman basal in my country. The article is spot on with the acidity. Sometimes it burns like hell. And it's not the long acting, but the fast acting insulin that gives me trouble. It's unpredictable and produces mixed results. Are you trying to say that you can have stable levels with diabetes on a daily basis with another form of insulin? Because I lost my marriage to the fear of hypos and will never get her back. Sorry I didn't meant to hijack this thread.

Yes, I am saying that. I found that Detemir (brand name Levemir) worked wonders. Others swear by Tresiba. Both worth seeing if you can get hold of. If you're having trouble with the fast acting causing hypos, it's likely you are having too much. Have you ever done any carb counting courses or had any explanation of how to use the insulin? If not, try out http://www.bertieonline.org.uk - it's a great resource.

 

[Notorious]

When I was on Lantus, I injected into my bum and this happened to me twice! It's awful and made me paranoid afterwards. I hypo'd for 4 solid hours. Up and down like a *****'s drawers

This happened to me twice too after injecting into my thighs. I switched to splitting the dose 50/50 morning and tea time. I would never take it right before bedtime. I have a pump now though.

 

[JUSTINB]

it is possible to hit a small vein, the worry is that if it happens regularly then the lengh og the needles you use may need to be ajusted as you may be going streight through subcut fat into the muscle ( can happen in ppl with low bodyfat percentages over well developed muscle areas ( i have shorter needles for my lantus as my legs have minimal fat and big muscles from cycling, i just wish i could lose the spare tyre)

 

[Steve14]

Yes, I am saying that. I found that Detemir (brand name Levemir) worked wonders. Others swear by Tresiba. Both worth seeing if you can get hold of. If you're having trouble with the fast acting causing hypos, it's likely you are having too much. Have you ever done any carb counting courses or had any explanation of how to use the insulin? If not, try out http://www.bertieonline.org.uk - it's a great resource.

Thank you! The problem I have is that e.g. I inject, then nothing happens up until 3 or 3&1/2 hours where I have a sudden hypo. I can just feel that the insulin is not working because I feel dehydrated all along, and then boom! If I try to counter-attack the hypo with a small carb source, then my levels shoot up above 10. All this has given me anxiety and I don't even leave my home anymore. And of course I will deal with the hypos because I'm scared of complications from hypers. I tried giving less, I tried giving more, but it never works as intended.... or if this is how it's intended to work, then I'm not sure if I want to live this way for another decade or even two-three more...

 

[tim2000s]

Hi @Steve14, there's been research into just how good we are as glucose monitors and the news on that front is that we are pretty rubbish. If you are going low at 3-3.5 hours after eating, then that usually indicates that you are taking too much insulin for the amount of carbs you are eating. Have you ever tested at 1 and 2 hours after eating? That will tell you whether you are really not seeing anything happening.

I strongly recommend you take a look at that course I posted, and test a bit more to understand what's really happening. You'll probably find you need to basal test and then reassess your bolus ratios.