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To pinch or not to pinch

Discussion in 'Diabetes Discussions' started by alphabeta, Jan 12, 2019.

  1. alphabeta

    alphabeta Type 1 · Well-Known Member

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    So today I was "lucky" enough that my Lantus didn't go into a vessel but very slightly went there. It was really not a big deal, my blood was 8.1 down to 3.9 in 30 minutes or less but up to 7.1 shortly after. It felt like a typical hypo accident thankfully it was not dramatic. I was thinking about pinching (thigh) but wanted to hear what is the current say in the community. I am a lean person what are your thoughts?
     
  2. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hi @alpha-beta whilst they say that accidental injection of insulin into a blood vessel is rare that is the ?second time you have reported such in ? 6 months. or less.
    In a previous thread you were informed that both Levemir and Tresiba are free of this problem of accidental intra-vascular injection causing hypos.
    Maybe nature is telling you to take the hint ??
     
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  3. alphabeta

    alphabeta Type 1 · Well-Known Member

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    Suppose that I change Lantus to either of the mentioned above, what do I do with Humalog? It pretty much causes the same thing. I avoid using my thighs because I see blood often after I inject but taking 4 injections in my arm is not a solution. Still, if I don't face this problem with Tresiba or Levemir, I will face it with Humalog, so questioning a change is irrelevant.
     
  4. Knikki

    Knikki Type 1 · Well-Known Member

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    I would have thought that using 4mm needles would get round the issue, however I guess even if you pinch, and in the pinch get a vessel, then nothing gained.

    However saying that it is certainly worth ago, it will not do you any harm. Used to pinch all the time using longer needles.

    Hope things go ok. :)
     
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  5. alphabeta

    alphabeta Type 1 · Well-Known Member

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    Already using 4mm though
     
  6. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hi @alphabeta,
    The effect of one dose of Lantus into the blood stream is likely to be far worse than a smaller dose of Humalog.
    So whatever you might say, it is relevant to try to remove Lantus, at one dose per day to ameliorate the risks you are worried about.
    And is your thinness inherited? Or is there a possible nutritional or diabetes issue there that might be amenable to improvement.? Does your injection technique need assessment?
    Please speak with your health team about these issues and listen to what they say.
    And rather than shooting down suggestions kindly made please consider them in the light of the purpose for which they were given.
     
  7. Knikki

    Knikki Type 1 · Well-Known Member

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    OK, you don't say where you inject but thought if you went into your butt you would have less chance of hitting something, but that said even I sometimes hit things and if it goes into a vessel it will get metabolised way quicker than it should, as you found out.

    I don't know what the answer is but still it's worth trying a pinch.

    Not to hard mind as it sometimes hurts ;) :)
     
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  8. alphabeta

    alphabeta Type 1 · Well-Known Member

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    Thanks @kitedoc!! I found them both Humalog and Lantus being equally bad I have virtually the same dose (12 Lantus/8-13 Hunalog). However, I am generally a thin person, the type that doesn't put on weight easily. My brothers are not like this. I try to manage diabetes as much as I can so that I gain weight (fat at least)
     
  9. alphabeta

    alphabeta Type 1 · Well-Known Member

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    My diabetes would be 1000 times less stressful if I didn't have to worry about this issue. Literally. Nothing scares me at all except this issue.
     
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  10. Knikki

    Knikki Type 1 · Well-Known Member

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    OK your slim.

    So let's think of areas where fat naturally accumulates.

    Butt, hips, stomach area all these are place where you are less likely to hit a vessel, that's not to say it 100% even after injecting for 50+ years I occasionally hit the odd vessel. But the areas mention are less likely, unless you really are stick thin ( no offence is intended) where you would encounter vessels.

    Hope you get sorted.
     
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  11. alphabeta

    alphabeta Type 1 · Well-Known Member

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    No offence taken :) I dont encounter any vessels in my upper arms but Lantus for me should go in the thigh otherwise it would make my sugar go bananas
     
  12. tim2000s

    tim2000s Type 1 · Expert
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    @alphabeta - the main reason for changing from Lantus to Levemir would be that even if you hit a blood vessel with Tresiba/Levemir, it doesn't disassociate into a fast acting insulin instantly, and remains in your blood as a long acting, so not only do you not get the instant hit, you would also have long acting insulin in your system for a significant duration, which you won't be seeing with the Lantus being absorbed way too fast.

    I'm fairly sure that you're not really injecting into a blood vessel - with the best will in the world, a capillary can't carry all the insulin away from your injection site that quickly. It's more likely that you inject into muscle due to lack of fat and catch a capillary, which speeds up all fast acting insulins. What I'd suggest for that is that you adjust the timing of your insulin,. If it makes you hypo very quickly, use it after meals rather than before.
     
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  13. alphabeta

    alphabeta Type 1 · Well-Known Member

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    Hey tim! Thanks for the input! What you are suggesting doesn't really solve my problem from the roots. I understand what you are saying and totally agree with you but what if it happens with Humalog? What if I see blood after injecting Humalog into my thigh? It has happened before and it is very nasty! I do take Lantus before bedtime, the last injection for the day. For starters, I am trying hard to keep my sugars below 10-12 where I won't be losing fat to high BG level at this level (staying below not at). I tried pinching last night and I must admit that I found it less painful; actually a bit ticklish? A bit leaked back but that was because I removed the pen way too early. Will pay attention tonight. I don't understand why pinching is frowned upon in some practices...
     
  14. JohnEGreen

    JohnEGreen Other · Expert

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    If a non injecting T2 may be so bold as to poke his nose in I did find the following while perusing the net.

    My experience in the area of injections is manly in giving them or receiving them and have only rarely injected myself.

    below is a quote from the linked article
    "
    Based on my own experiences, as both
    a person with diabetes and a nurse, I would
    recommend the following as a starting point:
    Longer needles for overweight and obese
    adults (BMI >27kg/m2
    ) using a pinched
    skinfold.

    Medium-length needles for normal-weight
    adults, children and adolescents using a
    pinched skinfold.

    Shorter needles for children and adolescents
    (aged 0–18 years) with or without an elevated
    skinfold, or adults without an elevated
    skinfold.

    Research published recently (Birkebaek et al,
    2008), suggests that 4mm needles reduce the
    risk of intramuscular injections, and can be used
    without pinching a skinfold; however, there is
    evidence that in lean young men there is still a
    risk of an intramuscular injection when insulin
    is given in the abdomen or thigh using a 5mm
    needle without an elevated skinfold (Frid, 2006). "

    https://www.diabetesonthenet.com/uploads/resources/dotn/_master/760/files/pdf/jdn12-10pg364.pdf
     
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  15. alphabeta

    alphabeta Type 1 · Well-Known Member

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    I see your point. However, I read that 4mm needles are a universal fit since we need at most 3.25 mm needle to reach the SQ tissue. I think an overweight patient can safely use 4mm but I won't concern myself with this. Thanks for the input!
     
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  16. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hi @tim2000s you make a good point about accidental intra-muscular injections. Thank you for that input.
     
  17. alphabeta

    alphabeta Type 1 · Well-Known Member

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    I feel that I am invisible wow
     
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  18. JohnEGreen

    JohnEGreen Other · Expert

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    I can still see you you are not invisible. :)

    Pinch or not pinch I do not think the is a proscribed or prescribed answer it's down to personal choice your build and what you are most comfortable with.
     
  19. tim2000s

    tim2000s Type 1 · Expert
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    Humalog also acts faster when injected into muscle (like quite a bit faster - I have longer needles to do intramuscular injections when required for precisely that reason). However, intramuscular injections are likely to be more painful than subcutaneous injections, which may be what you are experiencing. In my experience pain happens more often with intramuscular.

    If you have very low body fat, which it sounds as though you do, and every time you inject, it goes intramuscular, then you'll see that faster effect, which is why timing comes into play.

    What pinching does is to aggregate the subcutaneous fat into where you are going to inject and it should make the injection less painful and hopefully less aggressive.

    On the "Why does it bleed question?" that's a bit more tricky. If almost every injection you do is bleeding, I assume it's linked to the reduced body fat and the way your capillary network is affected by that.
     
  20. alphabeta

    alphabeta Type 1 · Well-Known Member

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    Hello again! I have been trying pinching for about 3 days? I find it MUCH BETTER! I can only pinch for my thighs not my arms (I have two hands only) but my arms are not a problem. I also noticed that when the needle goes in, way more comforting than not pinching, although I use 4mm needles. So far, I am enjoying accident-free nights and more peace of mind. I hope whoever stumbles upon this thread finds it helpful.
     
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