Injection Sites

[Merryterry]

I am getting consistantly high BG levels at the ,oment and cannot seem to consistantly get them down. I give extra units of insulin when high and it gets lower but the gets back to high. I have appointment with Nurse in 10 days time (yes earliest I can get) to discuss. I think I might be running out of injection sites. I use my thighs for Levermere overnight and my stomach fat, through my clothes, for daytime Novarapid. My stomach is a mass of scar tissue from operations. I live alone so cannot get injections into my Bum. Anybody got other suggestions?

 

[rebrascora]

Sorry to hear you are battling high BG levels. It can be very frustrating! When this happens to me and I inject a correction for high levels and it comes down and then goes back up again, then it is usually because my basal insulin dose (Levemir) is not correct.
Do you just take your Levemir once a day at night? If so, this may be part of the problem. Levemir typically does not last 24 hours (usually about 15-22 hours depending upon the size of the dose but it tails off significantly towards the end of it's activity range. Most of us need more basal insulin during the day, but injecting it all at night doesn't provide that. It was designed to be given in 2 doses, morning and evening rather than just once a day, so it may be that your nurse will suggest you split your Levemir dose if you don't already. It is certainly worth asking him/her about that option.

Is there a reason why you inject through your clothes? If you have lots of scar tissue on your tummy, you really need to expose the skin so that you can see where the scars are and avoid them. Injecting into scar tissue can mean the insulin is less effective as the blood supply in those areas will not be as good. The insulin could also get trapped in the scar tissue and possibly release much later when you least expect it, so important to avoid injecting near or into scars.

I inject my morning Levemir into my buttocks myself. I don't have any scars on my bum so I don't need to see where I am injecting there. I do it whilst I am lying in bed which I find makes it a lot easier and because I have what I consider quite a large dose (22units) I split it between each buttock and then inject my small evening dose (anywhere from 0-5 units) into alternate thighs each night. If I have done a lot of exercise I often don't need an evening dose hence the 0 dose some nights.

 

[Merryterry]

Thanks for reply. I do split my Levemir, 13 at night and 12 in the morning, as directed by my Doctor, injected in alternate thighs as you do. Lots of area there to enable moving sites.
I have to inject Novarapidthrough clothes, (shirt and vest pulling pullover up) as I have to wear braces to hold my trousers up. getting to bare stomach flesh difficult without partialy undressing (interesting in a Restaurant?).
This morning had light carb breakfast 10 units and BG went straight up to 13.6 and did not come down at all. Had lunch with a BG of 13.9.
Have just tried (Lunch) extra 2 units (12) with trousers down and lower stomach.
We shall see ?

 

[rebrascora]

You can also inject into your upper arms so that might be worth trying even through a shirt, although not ideal injecting through clothing and is supposed to be pretty much as fast as injecting into the abdomen, but my guess would be that your morning Levemir dose is probably not enough if you are needing corrections regularly through the day and as you mentioned, lowering levels a bit but then rising again.
Have you ever done a basal test to see if your basal insulin is holding your levels reasonably steady in the absence of food and bolus insulin. You do this by skipping meals (and bolus) in rota over a few days.... So one morning you skip breakfast and then the next day or a couple of days later you have breakfast but skip lunch and then the next, you have B and L but skip your evening meal. If your levels are drifting upwards during those periods when you are not eating, then that suggests that your Levemir is not holding you steady and you need to increase it. Obviously, if your levels drop and you are close to hypo, then you eat something and stop the test rather than risk a hypo.

 

[Lucyr]

You shouldn’t need to undo your braces to inject in your stomach, just untuck a bit of shirt and inject there. Or you can inject in your arms, I like there though it takes a little practice.

 

[trophywench]

@Merryterry - I'm certainly a lot less flexible than I was 50 years ago too but - forgive me cos I'm gonna be quite blunt here - whilst we can still wipe our own bum when we need to, there are certainly bits of our backside we can still reach especially as the hand operating the insulin pen does not ever touch the bit the needle goes in so the @rebrascora idea of jabbing the Levemir whilst still lying in/on your bed is not untoward.

Have you spoken to your clinic about these difficulties - if not, why?

 

[Merryterry]

You can also inject into your upper arms so that might be worth trying even through a shirt, although not ideal injecting through clothing and is supposed to be pretty much as fast as injecting into the abdomen, but my guess would be that your morning Levemir dose is probably not enough if you are needing corrections regularly through the day and as you mentioned, lowering levels a bit but then rising again.
Have you ever done a basal test to see if your basal insulin is holding your levels reasonably steady in the absence of food and bolus insulin. You do this by skipping meals (and bolus) in rota over a few days.... So one morning you skip breakfast and then the next day or a couple of days later you have breakfast but skip lunch and then the next, you have B and L but skip your evening meal. If your levels are drifting upwards during those periods when you are not eating, then that suggests that your Levemir is not holding you steady and you need to increase it. Obviously, if your levels drop and you are close to hypo, then you eat something and stop the test rather than risk a hypo.

Many thanks Rebascora but I think I have it cracked. I was 4.2 on rising this morning. Not been like that for weeks. I have changed my daytime injection sites to lower in my stomach, (trousers dow a bit.) and I think will be Ok. Bit loath to mess around with my Levermir as Doc told me not to change it.

 

[Merryterry]

@Merryterry - I'm certainly a lot less flexible than I was 50 years ago too but - forgive me cos I'm gonna be quite blunt here - whilst we can still wipe our own bum when we need to, there are certainly bits of our backside we can still reach especially as the hand operating the insulin pen does not ever touch the bit the needle goes in so the @rebrascora idea of jabbing the Levemir whilst still lying in/on your bed is not untoward.

Have you spoken to your clinic about these difficulties - if not, why?

Many thanks for reply but on the point about seeing my clinic I have an appointment but the earliest that can see me is 11 days away. this is the result of building thousands of houses (population now around 200,000), in my rural area of South Worcestershire and still only 2 GP Practices. i.e. 1 GP Practice per 100,00 people. Many of GPs part time or retired.