Injection site

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barbie3

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Type 1
Hope this is the right place to ask but how do you know where to inject? I have been told it must not be more than once a month into the same site and each injection must be an index finger apart but I can’t remember exactly where I have injected so how do you know? I am feeling totally overwhelmed having been diagnosed three weeks ago at the age of 72 and having to inject 4 times a day for type 1 diabetes. Thank you.
 
There is a good reason to vary your injection sites, to prevent lumps (lipohypertrophy) which would mean that injecting into the same spot would mean that insulin is not absorbed at a steady rate, giving unpredictable results.

I tend to just use my abdomen and follow a line from left to right, starting at almost my side. To be honest it’s hard to avoid a spot for a month - hard to remember which spots you have used. I did read one member makes a note on a chart each time he injects so that he can be better at avoiding the same spots. You can also inject into buttocks and thighs, but I’ve never done this and not had any issues so far (after 13 years of at least 4 injections per day).

Hope this helps!
 
Thank you. Maybe I will try making a chart until I get used to it all. Can’t bear the thought that this is what I will have to keep doing
 
Like @Eternal422 I chose to have a pattern to give me a clue where I injected. For me, this was left side for odd dates (1st, 3rd, 5th, ... of the month) and right side for even dates. I followed the same approach for selecting fingers for finger pricks testing.
Each day I would do a a hemi-semi-circle (a quarter of a circle) around my belly button. Some people chose to inject their basal in a dislocation such as thigh or buttocks due to absorption times. This also gives another area for injections. I did not worry about waiting a month before injecting in the same place. Partially due to lack of fat in enough places, partially due to cba-ness but mostly because I don't remember bring told to do so; just avoid injecting in the same area all the time.
I was injecting 4 to 10 times a day for 12 years until I switched to a pump. The high number of injections was mostly due to being a grazer. I have no lumps or absorption issues due to always using the same area
 
barbie3 said:
Can’t bear the thought that this is what I will have to keep doing
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It’s tough at first and initially I never thought I could even bring myself to inject, but very quickly it becomes second nature and you won’t think anything of it at all. Thankfully the needles are so fine and small that you don’t even feel them. Until quite recently I was on 8mm needles and pinching the skin to inject into, but with the 4mm needles it is so much easier and simple to inject without pinching.
 
The needles are so fine that hitting the same spot twice in a month might be less likely than winning the lottery jackpot and if you do, it doesn't mean anything desperately bad will happen, just that that tiny site is at a slightly higher risk of developing lipohypertrophy. I think if you are I were 5 or 6yrs old with small bodies and limited sites and a lifetime ahead of us, then it may be more important than being diagnosed much later in life. That said, I inject my basal (long acting) insulin into my thighs and buttocks and keep my stomach for bolus (meal time) injections and roughly rotate around my belly button veering right out to my sides above and below the belly button line, but I certainly don't have a set pattern I just have a rough idea in my mind of where my last few injections were and move round from that. With my buttocks, I work round in a circle and occasionally stick one in the middle. With my thighs, I tend to just jab in the tops at the front and alternate one to the other, but I usually just put a very small night time dose in them so just 1 or 2 units.

After 4 years, I can't see or feel any lumps or problems, so it looks like this slightly more random approach is working fine for me. I think sometimes it is easy to take something that a nurse says and put more emphasis on it that was intended or needs to be. I defy any nurse to know where she put an injection yesterday let alone a month ago. As I said, the needles are so tiny, you would really have to be incredibly unlucky to hit the same exact spot twice.

I also think it may be more of a problem if you are injecting large amounts of insulin into the same place. For this reason I split my basal dose because I take 22 units, so I put 11 into each buttock. Up to 20 units I didn't split it, but to me this spreads the insulin more evenly and will hopefully lead to more uniform absorption through my body. I was not told to do this but I believe people on much larger doses like 40 or 60 units are encouraged to split them and I think it may be these people who are more at risk from injection site complications/lumps developing..

I think if you lifted up your blouse and jabbed into the right hand side of your tummy 3 times a day, every day without variation, there would be a risk, but as long as you try to rotate sites and not keep jabbing into the same spot, it is fine and certainly not worth losing sleep over.
 
Never heard that before about not using same site for a month, really cant see why that would be, as rebrascora says above its very unlikely you'd hit exact same site twice.

Basal went in bum & thighs bolus in arms & stomach, with larger doses would split between 2 sites.
 
My system:

Basal in thighs, bolus in belly.

Even days are right side. Odd days are left side. Non-meal boluses (corrections and snacks) go on the opposite side.

For basal, I inject twice a day. Morning is further down my leg toward my knee. Evening is higher up nearer my hip. Early in the month is lower down (toward the chair if you're sitting). Later in the month is higher up (the part of the thigh that's facing up if you're sitting).

For bolus, I inject breakfast toward the centre of my belly, toward my bellybutton, lunch is a bit further out, and dinner is nearer my sides. Early in the month is further down toward my hips. Later in the month is further up (no higher than my bellybutton).

It might seem like a lot to keep straight, but I've gotten used to it and it's natural now. I don't always follow it 100% (if I'm eating out, I inject in whatever spot is convenient), but just trying gets me some rotation so I don't favour one spot.

I've also got a rotation system for finger prick. Even days are right hand. Odd days are left hand. Days 1-9 of the month start on the middle finger. Days 10-19 start on the ring finger. Days 20-31 start on the pinky finger. I leave my thumb and pointer finger out of the rotation. Each prick of the day moves to the next side or the next finger in the lineup.
 
barbie3 said:
Hope this is the right place to ask but how do you know where to inject? I have been told it must not be more than once a month into the same site and each injection must be an index finger apart but I can’t remember exactly where I have injected so how do you know? I am feeling totally overwhelmed having been diagnosed three weeks ago at the age of 72 and having to inject 4 times a day for type 1 diabetes. Thank you.
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Don’t worry too much. It’s just guidance so that you try to avoid re-using the same injection sites. It wouldn’t matter if you inadvertently used the same site again within a month. As long as you’re varying your injection sites and not always returning to a favourite area, then you should be ok.

The early weeks after a Type 1 diagnosis are hard. It can be overwhelming at first, but it does gradually get easier. It’s still a nuisance but that awful intenseness of the first few weeks does reduce.
 
Hi @barbie3 - one of the easiest places to get to for jabs for me, has always been what we used to know as a 'midriff bulge' - ie that bit of flesh which has always bulged over my waistband. Absorbs insulin really well and pretty quickly and really easy to get to and jab without needing to half undress just to eg eat my lunch. (As I worked in a professional office in the city centre most of my working life it could have been a prob if I'd been told I had to jab in my belly.)
 
In addition to areas others have mentioned I also use my upper arms as an alternative to my stomach. My DN suggested this and works well.
 
Take care when injecting in “other” areas that you have enough fat.
If you are slimmer, you may need to pinch and inject (yes, even when using the “newer” smaller needles, I have to pinch to ensure I do not inject too deep). I have never been able to inject in my arms because I would have to pinch and run out of hands to do so.
 
In the old days DSNs used to occasionally hand out little templates with circular holes spaced out to give you a target.

I jabbed for about 20 years before moving to an insulin pump (which leaves a small mark so is easier to keep track of!). I always tried to move sites about (using abdomen, thighs and buttocks), but was not given such a challenging set of instructions about a month between sites. My injection sites remained lumpless thankfully, so I guess I made the jabs far enough apart, or was lucky?
 
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