How often do you rotate injection sites? (T1)

[meggerz]

Hi, i have been diagnosed as T1 for about 13 years. For the first 12 years i injected solely into my stomach. Around a year ago i spoke to a nurse/doctor at my annual check up and she explained to me that i should be rotating sites (not just rotating around the stomach, but chance to side of the leg or buttocks), and asked me if i had small hard lumps under the skin of my stomach. I said i have and she said thats because of how long ive been injecting there.

After that conversation i changed to the side of my legs, and have been doing that since. I cannot remember how often she said i should be changing to another site, but i feel like a year is probably going to be long enough for the sides of my legs.

How often do you change from stomach to legs, legs to buttocks etc? Does anyone know how often the NHS recommend? I tried googling, but could only find information about rotating particular spots of each site.

Hopefully that makes sense, any information is appeciated.

 

[Nicola M]

I don’t think there’s particularly a set standard for how often you should use one site or not that I’ve ever been told. I’m on an insulin pump now but I was on injections for around 17 years, insulin pump now for 9-10 years. Everyone is different but I used to inject pens into my legs and I put my pump sites into my abdomen. The general rule of thumb is to make sure you inject/put a site around 1 inch away from the last place you injected into.

I split my stomach into “halves” so for around 1.5 months all my sites go onto the left side and then for the next 1.5 months they go onto the right side so both sides get a break. I’m generally okay with that, I have a slight lump on my stomach and I do avoid that area now but the rest of my stomach is fine.

As long as you are spacing your injections out and not using the same places all of the time you’ll stand a better chance of not getting lumps but there is always the risk there regardless of how carefully you change your injection locations.

 

[In Response]

I was injecting in my abdomen for 12 years before I started pumping.
I had a "side rule". On even dates, I used my right side for injections and right hand for finger pricks. On odd dates, I used my left side and left hand.
I would rotate around each side every day so that I kept each injection away from the last.

There were a few reasons for rarely using other sites
- as I am slim, I need to pinch. This is not possible on my arms and difficult to do on my bottom
- as I am very active, injecting in my legs would significantly increase my insulin sensitivity.
- anywhere apart from around my waist is not possible to access in "polite company" and I refuse to hide away to keep myself alive.

I have no hard lumps from following my regime. And, like @Nicola M I don't believe there are any set standards. However, I do think different body types are more susceptible to lumps so, for example, someone larger, may need to take more care with rotations.

 

[Jaylee]

Hi,

I put my basal in my leg, rotating sites in the same sort of way I was taught 48 years ago.
I was given a "butchers cut" style graph of the legs with the areas marked like days on a pill box..

Correction doses for me work well with Novorapid on the inner thigh, too.

If wearing shorts. I'll do legs for bolus.

Stomach most other times.
Doing the side of my abdomen so the jab can be concealed by a jacket or unzipped hoodie.

 

[meggerz]

I was injecting in my abdomen for 12 years before I started pumping.
I had a "side rule". On even dates, I used my right side for injections and right hand for finger pricks. On odd dates, I used my left side and left hand.
I would rotate around each side every day so that I kept each injection away from the last.

There were a few reasons for rarely using other sites
- as I am slim, I need to pinch. This is not possible on my arms and difficult to do on my bottom
- as I am very active, injecting in my legs would significantly increase my insulin sensitivity.
- anywhere apart from around my waist is not possible to access in "polite company" and I refuse to hide away to keep myself alive.

I have no hard lumps from following my regime. And, like @Nicola M I don't believe there are any set standards. However, I do think different body types are more susceptible to lumps so, for example, someone larger, may need to take more care with rotations.

Could you elaborate on the bolded part please? I am also very active, and didnt know this needed to be considered. I am not familiar with the concept of insulin sensitivity (feels like i should be... )

 

[Ushthetaff]

I I split legs and stomach into lines then inject into one leg next injection into other leg then one side of stomach then other side then back to first leg etc etc , obviously spacing injections so not injecting in same place ,

 

[In Response]

Could you elaborate on the bolded part please? I am also very active, and didnt know this needed to be considered. I am not familiar with the concept of insulin sensitivity (feels like i should be... )

In the simplistic terms I understand, if I run around after injecting in my leg (while the insulin is still active), my leg moves more which means my insulin reacts faster. Likewise, If I could inject in my arm, I would not do so if I was going to play tennis in the next 4 hours.

 

[meggerz]

In the simplistic terms I understand, if I run around after injecting in my leg (while the insulin is still active), my leg moves more which means my insulin reacts faster. Likewise, If I could inject in my arm, I would not do so if I was going to play tennis in the next 4 hours.

Thats very interesting. It would make sense aswell, because in the last year since ive been injecting into the side of my thigh, ive found that when i play golf, which is not overly exhausting but around a 5 mile walk, my blood sugar levels seems to plummit into oblivion. I understood that reaction to a heavy gym session or 90 minutes of football, but not to a round of golf.

Ill try making a conscious effort to inject on my stomach on days where i play football and golf, hopefully that will make it slightly easier to manage.

 

[Jaylee]

Thats very interesting. It would make sense aswell, because in the last year since ive been injecting into the side of my thigh, ive found that when i play golf, which is not overly exhausting but around a 5 mile walk, my blood sugar levels seems to plummit into oblivion. I understood that reaction to a heavy gym session or 90 minutes of football, but not to a round of golf.

Ill try making a conscious effort to inject on my stomach on days where i play football and golf, hopefully that will make it slightly easier to manage.

Is this your basal?

I find thigh basal injections (with no fast acting on board.) on gig nights prancing about like an idiot for nearly 2 hours.
Can keep me cruising around 5mmol long after the basal should have tailed off. Or even finished?
I’ve even had a mild hypo after packing down @1am.

 

[meggerz]

Is this your basal?

I find thigh basal injections (with no fast acting on board.) on gig nights prancing about like an idiot for nearly 2 hours.
Can keep me cruising around 5mmol long after the basal should have tailed off. Or even finished?
I’ve even had a mild hypo after packing down @1am.

I was referring to bolus, but, i think ill avoid the thighs on sporting days with both bolus and basal as an experiment.

 

[Jaylee]

I was referring to bolus, but, i think ill avoid the thighs on sporting days with both bolus and basal as an experiment.

Sorry, I tend not to have bolus on board or eat prior to a gig.
Can’t sing & digest food.. I’ll eat after.

For me with Novorapid. A correction dose on a high errant 20mmol when/if it happens, just needs what it needs with my insulin to carb ratio to correct?
I have to under dose this correction, if using my thigh..

I do tend to be on my feet a lot.

 

[becca59]

Use buttocks for basal, swapping weekly. Stomach for breakfast, leg for later in the day. I inject into leg prior to swimming though early in the morning, as I want it to work quickly as I shoot up. No breakfast til afterwards. I swap sides to match my buttocks weekly. So this week I am right side. I also use corresponding side for hands for blood tests. Though I do not do many of those these days.