Best injection site for me now

[gillrogers]

Still struggling with these darn spikes which seem to be getting higher but I come down by meal times so I keep being told my bolus is right. Because I was a skinny type 1 LADA with nofat on me I was injecting into my thighs. I'm wondering now I've got more fat on me since the correct LADA diagosis of changing it to my stomach. I'm going to speak to my dBn but wondered if there's anyone else with experience of changing from thigh to abdomen and how you got on with doing that.

 

[Thebearcametoo]

Kids often don’t have lots of fat on them so when mine was diagnosed we were told not to use arms but thighs, belly and bum were all suitable. Absorption speed varies with belly being fastest and bum slowest with thighs in between so you may find that your insulin is absorbed more quickly if you inject in your stomach and that may make a difference in when you inject to avoid the spike. Timing injections can be a tricky art. The other thing that can slow down spikes is to have more fat or protein with what you’re eating. Some carbs will spike more than others. Some people prefer to do low carb. As long as you know why you’re spiking and you return to in range after 4 hours then you’re broadly doing ok. Tweaking things to minimise spikes is helpful but there will always be some factors you can’t control and you can still get good long term management with imperfect numbers.

 

[Inka]

How high are you spiking @gillrogers ? I have a pump but when on pens I use all possible body areas just to make sure no area becomes over-used (which is very easy to do when you have a good area). I use my arms too, but have to be careful choosing the area.

 

[rebrascora]

I use my buttocks for basal and my stomach for bolus. If you are really thin, then pinching up can help but I think you would have to be quite emaciated not to have enough cover on your tummy unless you have longer needles than the normal 4mm.

As regards spiking and then coming back down before the next meal, it is down to the timing of your bolus injection. You need to experiment with carefully increasing the time between injecting and eating by a few mins every few days for each meal to find the best timing for you. If it gives you an idea of how much this can vary, it was typically taking me an hour and 15mins from injecting to eating my breakfast on Novo(not so)Rapid and about 20-30mins for meals at other times of day in order to prevent the spiking. With Fiasp which is a bit quicker I still need 45mins pre-bolus time on a morning and usually 15-20mins for other meals. That is just me but some people would hypo after just 15mins. You have to work out the best timing for you. If you have Libre it makes it easier because you can see when the insulin starts to kick in and that is usually when I start eating unless my readings were high to start with and then I wait until I get down to around 6 before eating.

 

[Kaylz]

I had no fat on me for at least 2 years after my diagnosis and still managed to use my stomach

If your coming back down then yes your bolus is probably correct just the timing could be off, thighs take longer to absorb the insulin than the stomach so for me personally breakfast and dinner is alternate thighs and 25 minutes pre bolus but tea I use my stomach and need to bolus immediately before eating xx

 

[helli]

Great advice from the others.
I just wanted to add my "thigh experience". Exercise will increase the absorption rate. This means, if you inject in your thighs and then go for a walk/run/cycle ride, the insulin will be absorbed faster.
As I am often active, but not always predictably, I avoided my thighs unless I was absolutely certain I would not be moving much in the next 3 or 4 hours. They were ideal for evenings but rarely any other time.

 

[rebrascora]

Great advice from the others.
I just wanted to add my "thigh experience". Exercise will increase the absorption rate. This means, if you inject in your thighs and then go for a walk/run/cycle ride, the insulin will be absorbed faster.
As I am often active, but not always predictably, I avoided my thighs unless I was absolutely certain I would not be moving much in the next 3 or 4 hours. They were ideal for evenings but rarely any other time.

I tried injecting into my thighs and then doing squats on a morning to hopefully hurry the insulin up a bit. Sadly it didn't work for me. 🙄 Or maybe the squats just encouraged my liver to dump even more glucose on top of my FOTF meaning the insulin had an even stronger tide to swim against!

 

[gillrogers]

How high are you spiking @gillrogers ? I have a pump but when on pens I use all possible body areas just to make sure no area becomes over-used (which is very easy to do when you have a good area). I use my arms too, but have to be careful choosing the area.

Anything from 15 to 18 @Inka

 

[gillrogers]

Kids often don’t have lots of fat on them so when mine was diagnosed we were told not to use arms but thighs, belly and bum were all suitable. Absorption speed varies with belly being fastest and bum slowest with thighs in between so you may find that your insulin is absorbed more quickly if you inject in your stomach and that may make a difference in when you inject to avoid the spike. Timing injections can be a tricky art. The other thing that can slow down spikes is to have more fat or protein with what you’re eating. Some carbs will spike more than others. Some people prefer to do low carb. As long as you know why you’re spiking and you return to in range after 4 hours then you’re broadly doing ok. Tweaking things to minimise spikes is helpful but there will always be some factors you can’t control and you can still get good long term management with imperfect numbers.

Hi , sometimes I'll crash during a meal or at then end so I got told not to pre bolus, just give at the start of my meal. Nurse said I didn't have to with humalog. Well I knew that wouldn't work. So gone back to 15 mins to 25 mins. Nutrition IST says not to go no more than 25 mins and my work activities says I can't really do that. So I thought about trying my tummy again. When I was type 2, I tried the basal (that's all I was on then) and crashed 4 hours later). A few months on I tried again and the same thing happened. Can't remember why I tried, doc must of said something. So I'm a bit wary of trying again but now I do know that the basal doesn't get injected to the stomach. Only bolus if you need to.

 

[gillrogers]

I use my buttocks for basal and my stomach for bolus. If you are really thin, then pinching up can help but I think you would have to be quite emaciated not to have enough cover on your tummy unless you have longer needles than the normal 4mm.

As regards spiking and then coming back down before the next meal, it is down to the timing of your bolus injection. You need to experiment with carefully increasing the time between injecting and eating by a few mins every few days for each meal to find the best timing for you. If it gives you an idea of how much this can vary, it was typically taking me an hour and 15mins from injecting to eating my breakfast on Novo(not so)Rapid and about 20-30mins for meals at other times of day in order to prevent the spiking. With Fiasp which is a bit quicker I still need 45mins pre-bolus time on a morning and usually 15-20mins for other meals. That is just me but some people would hypo after just 15mins. You have to work out the best timing for you. If you have Libre it makes it easier because you can see when the insulin starts to kick in and that is usually when I start eating unless my readings were high to start with and then I wait until I get down to around 6 before eating.

Hi Barbara, hope you are well , yes timing doesn't seem to make much difference at all. That's why I was thinking perhaps it's the absorption rate. If I'm absorbing it too slowly then it can't eat up the glucose as quick as it would if it was asorbed more quickly at the stomach area.

 

[rebrascora]

Hi Barbara, hope you are well , yes timing doesn't seem to make much difference at all. That's why I was thinking perhaps it's the absorption rate. If I'm absorbing it too slowly then it can't eat up the glucose as quick as it would if it was asorbed more quickly at the stomach area.

How far have you experimented with the timing?
You are right, the absorption rate is the key problem which is why the pre-bolus timing is so important, but you have to go far enough with it and do it carefully in small increments until you find the perfect timing for you. My consultant was horrified when I told him that I had to wait at least an hour and a quarter at breakfast time with Novorapid before eating but it was consistently that long and was the main reason why he swapped me to Fiasp, which still takes 45 mins before I can eat. I tend to inject it before I get out of bed and then potter on getting washed and dressed and coffee etc until I can see on my Libre that it is kicking in.
By all means start using your stomach as a site for your Bolus insulin as it may hopefully be a little quicker than your thighs but don't expect it to be much different. I would be surprised if it is any more than 5 mins quicker and probably significantly less. I would urge you to go back to experimenting with prebolus time.... The longer you give that insulin time to be absorbed and get going before you eat, the more that spike will reduce. If you wait too long, you will hypo, so you have to find the tipping point FOR YOU.

 

[gillrogers]

Ok, I have my breakie dose before I get up and give it 15 mins to 20 mins. If Im on a 7 and go 15 most of the time I'll go to a hypo by the time I've finished it. If I'm on 8 plus I'll bolus 20 mins and I'll go up to a 15 even if I get up right away .

Lunchtime and dinner time can be 25 mins. But again if I'm on a 7 and I go 15 minutes I'll go to hypo after I've eaten. It really odd that I have such a gap in timing. Fats in my breakfast are fairly high where as my other meals can tend to be much lower. I don't know how I can get more fats in other than mashed potatoes. We don't do much in way of puddings. I have to be careful with fats cos of cholesterol and I get confused with good and bad fats.

This is all still such a minefield isn't it.

 

[rebrascora]

Sorry, I missed Post #9 on this thread for some reason. It may be that you were waiting too long with some meals which is why you were crashing during the meal. Breakfast is usually the one that needs the longest pre-bolus time mostly I believe because it is fighting against the rise of glucose due to Dawn Phenomenon or Foot on the Floor syndrome. I find breakfast prebolus timing is the most consistent but that is mostly because I have a similar breakfast every day I guess. Later in the day the prebolus time is less critical and will also vary according to what you eat and also your starting BG reading. If your BG is high when you inject you will need longer to let it get to work than if it is say 5 or 6. Less time still if it is in the 4s. Fatty meals and meals with a lot of fibre will dlow your digestion, so the insulin can kick in before the glucose hits the blood stream and cause you to hypo. Exercise before the meal can cause your levels to drop mid meal..... So many factors can affect it but for me, persevering with finding the correct timing of that bolus insulin (particularly at breakfast) was important because those spikes up to mid teens and then plummeting every mid morning made me feel rubbish even though I wasn't hypoing. I know for certain that my consultant would have told me not to go beyond 30mins but my body needs considerably longer on a morning and I am not the only person to find that. He accepts that now because he has seen my graphs and it is very reproduceable, so I prefer to encourage people to find what works for them by experimenting (with one eye carefully on safety) rather than follow set rules given out by clinicians.

 

[rebrascora]

Ok, I have my breakie dose before I get up and give it 15 mins to 20 mins. If Im on a 7 and go 15 most of the time I'll go to a hypo by the time I've finished it. If I'm on 8 plus I'll bolus 20 mins and I'll go up to a 15 even if I get up right away .

Lunchtime and dinner time can be 25 mins. But again if I'm on a 7 and I go 15 minutes I'll go to hypo after I've eaten. It really odd that I have such a gap in timing. Fats in my breakfast are fairly high where as my other meals can tend to be much lower. I don't know how I can get more fats in other than mashed potatoes. We don't do much in way of puddings. I have to be careful with fats cos of cholesterol and I get confused with good and bad fats.

This is all still such a minefield isn't it.

Is there a difference in what you eat with those two results as that can make a big difference?

 

[rebrascora]

Another way to approach it would be to have a low carb breakfast without a bolus and see how you get on. Something like an omelette.

 

[gillrogers]

Is there a difference in what you eat with those two results as that can make a big difference?

Yes I think it's the amount of fat. My brastfast has 100ml of full fat freak yogurt in it. But my lunch and dinners tend to have a lot less fat in them. I think alot of it goes back to about 3 years of heavy stress that forced me into a veganish diet and had to cut fats and animal produce out as I couldn't digest it. Turns out it wasn't the stress but a gluten intolerance. Now the gluten has gone so I can eat animal fats and products again.

 

[gillrogers]

Sorry, I missed Post #9 on this thread for some reason. It may be that you were waiting too long with some meals which is why you were crashing during the meal. Breakfast is usually the one that needs the longest pre-bolus time mostly I believe because it is fighting against the rise of glucose due to Dawn Phenomenon or Foot on the Floor syndrome. I find breakfast prebolus timing is the most consistent but that is mostly because I have a similar breakfast every day I guess. Later in the day the prebolus time is less critical and will also vary according to what you eat and also your starting BG reading. If your BG is high when you inject you will need longer to let it get to work than if it is say 5 or 6. Less time still if it is in the 4s. Fatty meals and meals with a lot of fibre will dlow your digestion, so the insulin can kick in before the glucose hits the blood stream and cause you to hypo. Exercise before the meal can cause your levels to drop mid meal..... So many factors can affect it but for me, persevering with finding the correct timing of that bolus insulin (particularly at breakfast) was important because those spikes up to mid teens and then plummeting every mid morning made me feel rubbish even though I wasn't hypoing. I know for certain that my consultant would have told me not to go beyond 30mins but my body needs considerably longer on a morning and I am not the only person to find that. He accepts that now because he has seen my graphs and it is very reproduceable, so I prefer to encourage people to find what works for them by experimenting (with one eye carefully on safety) rather than follow set rules given out by clinicians.

Waiting between meals wasn't the problem as I make a point of eating around the same time of day, especially as it fits in with my work routine. There has been odd times where I've had to go do cleaning the village hall before a meal and ended up low during the meal but I've identified those situations. Aga just remembered the other time was when we discovered my basal had dropped 2 units after about 2 months of stress.

Soooo, narrowed it back to good old timing again with possably a bit of slow absorption due to my injection location.

 

[rebrascora]

That is exactly the problem with diabetes isn't it. So many factors other than just food and insulin to consider which makes it so much more difficult to see the patterns and figure out the best strategy to tackle problems. Pleased you got your gluten intolerance sorted and can go back to meat and dairy.
I too have about 100g creamy Greek yoghurt for breakfast, preceded by coffee with cream, so lots of fat but my digestive system seems to ignore all that and the glucose still hits my blood stream incredibly quickly whereas the insulin takes what seems like forever.
If your basal is not right that makes an an enormous difference too and I sometimes have to tweak my basal on an almost daily basis to be balanced and then other times I can go many weeks or months on the same doses. It all keeps you on your toes that's for sure!
Hope your change of injection site improves things a bit for you.

 

[Inka]

Anything from 15 to 18 @Inka

Ah, ok - that’s difficult then. I think a reasonable spike is ok as long as it comes down, but for me personally 15-18 would be too large a spike. @rebrascora has already mentioned pre-bolusing, which is a crucial tool, and which can make a massive difference, so I’d look at that again eg with Humalog I need to bolus twice as far in advance for breakfast as other meals. When I was pregnant and had the associated insulin resistance, I actually needed to bolus around 50+ mins prior to having my breakfast! Now it’s 30 mins.

You could, after investigating that, also consider a small increase in your bolus for certain meals. If your blood sugar then drops a while later, you can simply have a small snack eg 5/10/15g carbs or whatever without a bolus. That way you control the spike.

If your spike is very brief, I’d just leave it.

 

[gillrogers]

Ah, ok - that’s difficult then. I think a reasonable spike is ok as long as it comes down, but for me personally 15-18 would be too large a spike. @rebrascora has already mentioned pre-bolusing, which is a crucial tool, and which can make a massive difference, so I’d look at that again eg with Humalog I need to bolus twice as far in advance for breakfast as other meals. When I was pregnant and had the associated insulin resistance, I actually needed to bolus around 50+ mins prior to having my breakfast! Now it’s 30 mins.

You could, after investigating that, also consider a small increase in your bolus for certain meals. If your blood sugar then drops a while later, you can simply have a small snack eg 5/10/15g carbs or whatever without a bolus. That way you control the spike.

If your spike is very brief, I’d just leave it.

I had actually thought about doing that inka, but was abit unsure. But now you e suggested it, it could be a possibility as I miss my 10am snack lol