Injecting in more than 1 site and impact on absorption rate

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Jon-Manchester

Jon-Manchester

Well-Known Member
Relationship to Diabetes
Type 1
Hello all,

After a hyperglycaemic event the other day I started to wonder about insulin absorption rates.
Let's for n argument say, that the blood sugar is at 18 and you decide that you need to take 6 units of fast-acting insulin to bring it down.
You could take it as 1 dose of 6 units or you could split it, so you take 3 units on the right side and then the other 3 on the left side of your belly.
Given that the 2 sites are far enough away from each other, would you get twice the absorption rate versus doing 1 injection?
Basically, I am thinking if you want to bring down the bloodsugar quicker, does it help to split the dose and do it on two different sites?

Does anyone know or have any thoughts?

Many thanks
Jon
 
Jon-Manchester said:
Basically, I am thinking if you want to bring down the bloodsugar quicker, does it help to split the dose and do it on two different sites?
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I guess in theory it might make some difference. I'd be astonished if it would make enough difference to be worth doing. Especially for 6 units (6 hundredths of a ml!). I think most of the delay is just how the insulin works, not absorption in a physical sense.
 
Jon-Manchester said:
Hello all,

After a hyperglycaemic event the other day I started to wonder about insulin absorption rates.
Let's for n argument say, that the blood sugar is at 18 and you decide that you need to take 6 units of fast-acting insulin to bring it down.
You could take it as 1 dose of 6 units or you could split it, so you take 3 units on the right side and then the other 3 on the left side of your belly.
Given that the 2 sites are far enough away from each other, would you get twice the absorption rate versus doing 1 injection?
Basically, I am thinking if you want to bring down the bloodsugar quicker, does it help to split the dose and do it on two different sites?

Does anyone know or have any thoughts?

Many thanks
Jon
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I've often wondered but never tried, may give it a go, nowt to lose as I'm spiking after meals not working quick enough. Dare not jab before as I'd forget. Sites though do they make any difference for you? My arms and legs I get nothing, it just don't work only in belly.
 
I was advised by my DNS not to stack my Novorapid, i.e., it lasts for 4 hours and therefore i shouldn't inject more before the 4 hours have passed. Not sure why though.
 
Paul Goldie said:
I was advised by my DNS not to stack my Novorapid, i.e., it lasts for 4 hours and therefore i shouldn't inject more before the 4 hours have passed. Not sure why though.
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There is a resistance to insulin stacking for corrections because most "fast acting" insulin is still working for 4 or 5 hours. So, if you correct whilst you have active insulin on board (IOB), your body has twice as much insulin as you need.

This is different to splitting a dose over two or more injections which is not uncommon when eating high carb high fat food such as pizza. When splitting insulin doses, you are taking the same amount of insulin that you have calculated.
 
helli said:
There is a resistance to insulin stacking for corrections because most "fast acting" insulin is still working for 4 or 5 hours. So, if you correct whilst you have active insulin on board (IOB), your body has twice as much insulin as you need.

This is different to splitting a dose over two or more injections which is not uncommon when eating high carb high fat food such as pizza. When splitting insulin doses, you are taking the same amount of insulin that you have calculated.
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that makes sense, thank you for explaining.
 
Paul Goldie said:
Not sure why though.
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Simplicity (to reduce the chances of hypos).

A single injection of 10 units of bolus is fairly simple: activity increases, reaches a maximum 90 minutes or so later and that gradually decreases until it's pretty much nothing after 4-5 hours. (The precise times vary depending on person, injection site, time of day, dose, etc.)

Two injections one after the other are also fine: you can inject 10 units in one injection or two of 7 and 3 (or something) and it's just the same. But an injection of 5 units followed an hour later by another of 5 units produces two of these curves at the same time, so it's harder to keep track of how much insulin is still active. (Bolus calculators try to keep "insulin on board" estimates to try and handle this. But all these things are approximations.)

Doesn't mean one should never stack insulin like that, but it does make things more complex, so it's worth avoiding when practical.
 
Tried it for a day split in half, top belly, bottom belly, no difference. Thinking about it why would it its same dose, just going in 2 holes at same time.
 
I split doses into 2 sites for my larger daytime basal insulin dose.... Currently 12u into each buttock because I think 24 in one site is quite a lot and if absorption is compromised for some reason, splitting it at least provides me with some cover. It may be overkill on my part as I know many people inject larger doses in one go, but it just seems logical to me to take that precaution. Under 20 units I didn't bother but when my basal needs hit 20+ I decided a split was a good idea.
 
The problem with corrections when your levels are really high is that the higher your BG the more insulin resistance it causes, so I certainly find that once I get above 10 I need much more insulin to bring me down ie a bigger correction factor than below 10. Above 13 and I might as well be injecting water and I have to be pretty heavy handed to bring it down.
For that reason I am quite proactive about keeping my baseline readings below 8 as much as possible, so if my levels are drifting upwards 2-3 hours after food and bolus when levels should be coming down not going up, I will stick in a correction straight away and monitor closely. I might find that it continues to drift upwards and I need another correction an hour later or it may come down fast and I need a very small carb snack like 1 dried apricot or a JB to slow the drop if it gets to mid 5s and still dropping fast. I believe this is called "sugar surfing" although I didn't know that when I first started doing it and it works well for me in keeping levels in range.
 
Not that I subscribe to all Bernstein's ideas, but he advises splitting any dose over 7u to aid absorption. I've seen that elsewhere too, but can't think where.
 
Told years ago by consultant that large doses should be split, one reason better absorption other being less chance of injection site issues.

Years since on pens, but remember basal dose was 20u, so would put 10u in left bum cheek 10 in right. Did find had far less problems with sites using this technique.
 
rebrascora said:
I split doses into 2 sites for my larger daytime basal insulin dose.... Currently 12u into each buttock because I think 24 in one site is quite a lot and if absorption is compromised for some reason, splitting it at least provides me with some cover. It may be overkill on my part as I know many people inject larger doses in one go, but it just seems logical to me to take that precaution. Under 20 units I didn't bother but when my basal needs hit 20+ I decided a split was a good idea.
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Wow 20! Can totally see where your coming from.
 
nonethewiser said:
It's not high dose, once over was on 30u of lantus, there's people on lot more & lot less.

Since moving to pump basal dose is around 16u.
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Oh lantus, get it now, that's fast and slow together ain't it, used to give it to daughter when she was a kid, twice a day.
 
Pattidevans said:
Not that I subscribe to all Bernstein's ideas, but he advises splitting any dose over 7u to aid absorption. I've seen that elsewhere too, but can't think where.
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Pattidevans said:
Not that I subscribe to all Bernstein's ideas, but he advises splitting any dose over 7u to aid absorption. I've seen that elsewhere too, but can't think where.
Click to expand...

It was the 7u I thought of too - I think there’s a suggestion that for larger single doses it’s possible for the absorption to be less reliable, and that some units may ‘go missing’.

I had half a thought it might be John ‘Using Insulin’ Walsh who said something similar, but I might be completely wrong!
 
everydayupsanddowns said:
It was the 7u I thought of too - I think there’s a suggestion that for larger single doses it’s possible for the absorption to be less reliable, and that some units may ‘go missing’.

I had half a thought it might be John ‘Using Insulin’ Walsh who said something similar, but I might be completely wrong!
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I think you’re right Mike, I’ve got both “Using Insulin” and “Think like a Pancreas” and I knew it was one of those.
 
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