Injection Sites

[pawprint91]

I think I asked this a while back when I was first diagnosed, I also asked the dsn that I spoke to in January, but still feel none the wiser really, so thought I'd ask on here!

I only use my stomach for novorapid - is this sustainable forever? I am very careful to rotate around and it's probably a 5 day period between each 'site' on my stomach is reused (I imagine it like a grid).

I do my basal in my thighs - did try it in my buttocks for a while, but moved back to thigh. Does this mean I can now never use my thigh (or my buttocks?) for bolus insulin - I remember from my thread before that you are not supposed to inject them in the same place.

The dsn also said they don't advise anyone to use their arms anymore (I am guessing for fear of injecting into muscle and increasing hypos) but come the summer I am considering giving my poor old stomach a break and having a go there.

What does everyone else do? 🙂

 

[Tdm]

Bottom for basal ( bottom is slowest acting so suiable for basal) tummy for bolus when i want quick result, thighs and upper leg for bolus generally
Id think bout spreading sites a bit wider.
Perhaps top thigh right for 1 weeks, top left thigh when you change libre, perhap use side thighs basal?
I mark circle with pen so i can see where i have been last couple days ...this may be abit much for some and the red injection spot lasts couple of days

 

[Spathiphyllum]

I think I asked this a while back when I was first diagnosed, I also asked the dsn that I spoke to in January, but still feel none the wiser really, so thought I'd ask on here!

I only use my stomach for novorapid - is this sustainable forever? I am very careful to rotate around and it's probably a 5 day period between each 'site' on my stomach is reused (I imagine it like a grid).

I do my basal in my thighs - did try it in my buttocks for a while, but moved back to thigh. Does this mean I can now never use my thigh (or my buttocks?) for bolus insulin - I remember from my thread before that you are not supposed to inject them in the same place.

The dsn also said they don't advise anyone to use their arms anymore (I am guessing for fear of injecting into muscle and increasing hypos) but come the summer I am considering giving my poor old stomach a break and having a go there.

What does everyone else do? 🙂

Hi Pawprint! I was diagnosed only a couple of months after you, and I'm now feeling much the same-- my poor old stomach could do with a break! I've been using tummy for Fiasp and thighs for Tresiba.

I'm thinking of switching to my behind for Tresiba and thighs for Fiasp, at least for a little while. Everyone, including DSNs, says absorption from injecting in the abdomen is faster than injecting in thighs. But I'm gradually getting better at planning meals to allow time for 'pre-bolusing'. (And, for breakfast, I've been getting better at dealing with my internal toddler who demands 'Food! Now!')

I am also considering upper arms for Fiasp, though. From what I've read, it is as you guessed: advice is generally not to use arms due to risk of injecting into muscle. Of course the level of risk will depend on how much subcutaneous fat you have on your arms vs how much muscle.

I don't have much fat on my arms and do have a bit of muscle. But-- I also have something my DSN kindly gave me which is superb: https://www.tickleflex.com/ It was invented by an engineer who developed Type 1 as an adult, designed partly for needle-phobes and partly for skinny people. Sucks up a little bump of subcutaneous tissue to inject into, precisely to avoid injecting into muscle.

And, with regard to speed of absorption, it seems the upper arm is as fast as the abdomen (faster than thigh or butt): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6079517/

Like you, I would be very interested to hear what others do! And particularly whether anyone has used their upper arms and how they got on with it. All best wishes, and hope you've had a happy Easter!

 

[Eternal422]

I use my tummy for Levemir and NR, but always try to progress from one side to the other so as to avoid injections into the same area continually. Been using my tummy for over 15 years now without any issues.

I think we all have a favoured location to use if we didn’t consciously try to alter it. My DSN did recently suggest buttocks for basal, but I’ve never tried that. I must admit though, at the moment I have a line of bruises which I’d rather not have and can understand why it’s not desirable especially if you’re swimming or dressed for the beach. I guess I should be braver and attempt another location at least for some of the injections!

 

[pawprint91]

Bottom for basal ( bottom is slowest acting so suiable for basal) tummy for bolus when i want quick result, thighs and upper leg for bolus generally
Id think bout spreading sites a bit wider.
Perhaps top thigh right for 1 weeks, top left thigh when you change libre, perhap use side thighs basal?
I mark circle with pen so i can see where i have been last couple days ...this may be abit much for some and the red injection spot lasts couple of days

Thanks for this - I was told not to use the same site for different types of insulin though - so if using thigh for basal it shouldn't used for bolus too? Not sure if this means my thighs are now written off forever as 'basal' or if they would just need a break before being used for bolus?

 

[pawprint91]

I'm thinking of switching to my behind for Tresiba and thighs for Fiasp, at least for a little while. Everyone, including DSNs, says absorption from injecting in the abdomen is faster than injecting in thighs. But I'm gradually getting better at planning meals to allow time for 'pre-bolusing'. (And, for breakfast, I've been getting better at dealing with my internal toddler who demands 'Food! Now!')

Hope you're getting on okay with it all 🙂 have you heard/been told about not using one site for bolus when you've used it for basal?(Which would mean we can't switch to thigh after tummy ... I could be wrong though!)

 

[pawprint91]

I use my tummy for Levemir and NR, but always try to progress from one side to the other so as to avoid injections into the same area continually. Been using my tummy for over 15 years now without any issues.

I think we all have a favoured location to use if we didn’t consciously try to alter it. My DSN did recently suggest buttocks for basal, but I’ve never tried that. I must admit though, at the moment I have a line of bruises which I’d rather not have and can understand why it’s not desirable especially if you’re swimming or dressed for the beach. I guess I should be braver and attempt another location at least for some of the injections!

Thanks for your reply - I did try my buttocks for basal for a few weeks and was surprised at how flexible I was when it came to reaching round

 

[Spathiphyllum]

have you heard/been told about not using one site for bolus when you've used it for basal?(Which would mean we can't switch to thigh after tummy ... I could be wrong though!)

I've never heard that, and never read anything that would justify it ...

The idea of using different types of site for basal and for bolus makes sense, simply to a) reduce use of 'valuable real estate' on the tummy, which I think is where most people inject bolus, and b) reduce risk of confusion, in the same way that we're advised to have different coloured pens for basal on the one hand and bolus on the other.

But I can't think of any reason not to, for example, switch from tummy bolus and thigh basal to thigh bolus and buttock basal-- at least provided that, in the first day or two, you don't inject your boluses very near the same place you injected your last basal.

When you inject insulin, or when your pump infuses a bit of insulin, it forms a little 'depot', a little blob, in your subcutaneous tissue; and then, as the insulin is absorbed, that 'depot' dissolves and then disappears. (On a quick search, see e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692237/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298133/ .)

I can see that it might not be a good idea to inject your bolus insulin in exactly the same place you've still got a basal depot. But: Say you last injected your basal in your left thigh. I can't see any reason why you shouldn't inject your next bolus in your right thigh-- or even in, say, the lower part of your left thigh if your last basal was in the upper part of your left thigh. Then next basal in buttock, and by the next day-- maybe wait 2-3 days if you've been using Tresiba as your basal-- you wouldn't have any basal left in your thighs, so you could inject bolus wherever on your thighs you wanted.

If anybody knows any different, do say!

 

[Inka]

Hope you're getting on okay with it all 🙂 have you heard/been told about not using one site for bolus when you've used it for basal?(Which would mean we can't switch to thigh after tummy ... I could be wrong though!)

You’re not supposed to inject them near each other at the same time (that is, it wouldn’t matter if you used a basal site for bolus some days later) but you could use the same body area, eg basal in right thigh, bolus in left thigh.

 

[pawprint91]

You’re not supposed to inject them near each other at the same time (that is, it wouldn’t matter if you used a basal site for bolus some days later) but you could use the same body area, eg basal in right thigh, bolus in left thigh.

This makes sense! So just wait a few days before making the switch - I totally misunderstood what the nurse said (which was basically don't use them both for the same thing - but she didn't really expand!). Maybe ahead of the summer I'll switch basal to buttocks and bring back bolus on the leg, makes it easier when eating out in long dresses etc

 

[pawprint91]

I've never heard that, and never read anything that would justify it ...

The idea of using different types of site for basal and for bolus makes sense, simply to a) reduce use of 'valuable real estate' on the tummy, which I think is where most people inject bolus, and b) reduce risk of confusion, in the same way that we're advised to have different coloured pens for basal on the one hand and bolus on the other.

But I can't think of any reason not to, for example, switch from tummy bolus and thigh basal to thigh bolus and buttock basal-- at least provided that, in the first day or two, you don't inject your boluses very near the same place you injected your last basal.

When you inject insulin, or when your pump infuses a bit of insulin, it forms a little 'depot', a little blob, in your subcutaneous tissue; and then, as the insulin is absorbed, that 'depot' dissolves and then disappears. (On a quick search, see e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692237/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298133/ .)

I can see that it might not be a good idea to inject your bolus insulin in exactly the same place you've still got a basal depot. But: Say you last injected your basal in your left thigh. I can't see any reason why you shouldn't inject your next bolus in your right thigh-- or even in, say, the lower part of your left thigh if your last basal was in the upper part of your left thigh. Then next basal in buttock, and by the next day-- maybe wait 2-3 days if you've been using Tresiba as your basal-- you wouldn't have any basal left in your thighs, so you could inject bolus wherever on your thighs you wanted.

If anybody knows any different, do say!

Thank you - I do apologise, as I said above, I think I had it poorly explained to me by a DSN nurse, this makes a lot of sense, thank you! (Still considering the arm, though! 😉 )

 

[Finn]

Thanks for this - I was told not to use the same site for different types of insulin though - so if using thigh for basal it shouldn't used for bolus too? Not sure if this means my thighs are now written off forever as 'basal' or if they would just need a break before being used for bolus?

From what I've read, if you inject basal and bolus near each other in the same injection session, the insulins could kind of compete with each other and one wouldn't work as well as intended, or one would work better than intended. I can't remember which way around it said and I don't know if it's true.

If it is true, then for predictable blood sugars, it's best to inject in different places, or different times if using the same site.

It's also good to inject basal and bolus insulins into spots that you can predict their absorption. So if thighs are slower and you inject basal there, sticking with that will give you predictability. If tummy is faster and you inject bolus there, you'll have a better idea of how it will work.

Regardless, for site health, it's important to rotate your injection sites, whether they're basal or bolus. A needle does the same damage to your skin and tissues whether it's delivering basal or bolus insulin.