Novorapid & injecting into stomach ... any tips?

[pawprint91]

So .... 6 weeks later and after being 'politely pushy' (as one lovely member on here advised me to be a few weeks ago) with my diabetes team, I am finally on 2 units of novorapid before my evening meal (meaning I'm more confident to follow the advice of 'eat what you want'...!) I'm also now able to inject into my stomach, something I've never done before. I was told to avoid the area 'immediately round the belly button' and that I can pinch the skin if I want to, but other than that, does anybody have any tips on angle etc? Also, does novorapid work best injected into stomach or leg?

On a side note, I'm also now on basal insulin (Levemir) in the morning only to avoid hypos overnight, as my levels were still dropping overnight, although not dangerously - from a 12 post meal spike to say a 7. I was only on one unit in the pm anyway, and dn said that with the introduction of novorapid, she didn't want to risk going too low - I know I'm in this annoying honeymoon phase and everybody is different, but does this sound right? Thank you as always to everyone in advance!

 

[rebrascora]

Hi. Great to hear that being "politely pushy" got you some Novo juice. I was advised that injections should be at 90 degrees to the skin so straight rather than angled. Many DSNs seem to discourage pinching up but I can't see any negative to doing it and some positives in that it stretches the skin a little and that can aid the needle pushing through and the sensation of pinching (not hard obviously) distracts from any discomfort from the needle. Pinching up was a very common techniquie when needles were longer and particularly when people had lost a lot of weight at diagnosis, to ensure that the insulin went in the appropriate layer under the skin. These days with the tiny needles we have, it isn't necessary, but in my opinion, can still be helpful.
Most people find that the stomach absorbs insulin slightly faster than the thighs or buttocks. I generally use my stomach for bolus insulin and my buttocks and thighs for Levemir.
As regards stopping your evening Levemir, that sounds like a good plan for now. I am out of the honeymoon period but there are times when I don't need any Levemir on an evening, particularly if I have done a lot of activity on consecutive days. My morning dose is always significantly higher than my evening dose..... today it is 24u in the morning (before I get out of bed) and will be reducing to just 3u tonight. That is just me though, at this moment in time and it is something that changes with the seasons and activity and health etc. Getting your basal insulin dose(s) right is the key to good diabetes management and it is always a work in progress, although some people seem to have much more stable basal needs than others. I can sometimes be needing to change mine on a daily basis. The great thing about Levemir is that it allows you to do that..... but you don't need to worry too much about that at the moment because your own pancreas will be taking up a lot of the slack. Just wanted to reassure you that yes taking just one dose of Levemir in the morning at this stage is a good strategy if your levels are dropping overnight with just 1 unit.

Good luck with the NR. How far in advance of eating your meal has the nurse recommended you inject?

 

[Bruce Stephens]

does anybody have any tips on angle etc? Also, does novorapid work best injected into stomach or leg?

Presuming the usual 4mm needle, straight in (so a 90 degree angle to your skin) since 4mm should get you through the skin but not too far in. And you can expect faster action in the stomach than the leg but probably not that much faster.

 

[helli]

These days with the tiny needles we have, it isn't necessary, but in my opinion, can still be helpful.

I know what you mean but I would not say a pinch is unnecessary for all of us.
If you have little fat, pinching is still necessary. I found even a 4mm needle goes in too far for me as I am quite slim.

@pawprint91 the only additional advice is to try to come up with a pattern for your injecting to avoid always jabbing in the same place. At this stage with very small doses it won't make a huge amount of difference but over the years it can build up scar tissue which leads to delaying insulin absorption. So It is a good idea to start out how you plan to carry on.
Before I started my pump, I used to do things like use the left hand side of my body (and fingers for testing) on odd numbered dates (1st. 3rd, 5th, ... of the month) and the right side for even dates. I would inject slightly higher for breakfast, lower for lunch and lower still for dinner. I was not accurate or precise (I never had my abdomen tattooed with an "insulin map") but it encouraged me to change my spots.

 

[pawprint91]

Hi. Great to hear that being "politely pushy" got you some Novo juice. I was advised that injections should be at 90 degrees to the skin so straight rather than angled. Many DSNs seem to discourage pinching up but I can't see any negative to doing it and some positives in that it stretches the skin a little and that can aid the needle pushing through and the sensation of pinching (not hard obviously) distracts from any discomfort from the needle. Pinching up was a very common techniquie when needles were longer and particularly when people had lost a lot of weight at diagnosis, to ensure that the insulin went in the appropriate layer under the skin. These days with the tiny needles we have, it isn't necessary, but in my opinion, can still be helpful.
Most people find that the stomach absorbs insulin slightly faster than the thighs or buttocks. I generally use my stomach for bolus insulin and my buttocks and thighs for Levemir.
As regards stopping your evening Levemir, that sounds like a good plan for now. I am out of the honeymoon period but there are times when I don't need any Levemir on an evening, particularly if I have done a lot of activity on consecutive days. My morning dose is always significantly higher than my evening dose..... today it is 24u in the morning (before I get out of bed) and will be reducing to just 3u tonight. That is just me though, at this moment in time and it is something that changes with the seasons and activity and health etc. Getting your basal insulin dose(s) right is the key to good diabetes management and it is always a work in progress, although some people seem to have much more stable basal needs than others. I can sometimes be needing to change mine on a daily basis. The great thing about Levemir is that it allows you to do that..... but you don't need to worry too much about that at the moment because your own pancreas will be taking up a lot of the slack. Just wanted to reassure you that yes taking just one dose of Levemir in the morning at this stage is a good strategy if your levels are dropping overnight with just 1 unit.

Good luck with the NR. How far in advance of eating your meal has the nurse recommended you inject?

Thank you for this 🙂 is 'pinching up' just pinching the area you want the needle to go in to raise it and therefore make the process easier/more comfortable (as you said)?

Thank you for the reassurance re: basal too - just out of interest as someone who obviously has good knowledge/management of their diabetes, do you make your own decisions on your basal, or does it always have to be discussed with your team in advance?

I was told to inject 10-15 mins before eating ideally, but told right before would be fine if I was out etc. She also said that she wants me to eat some pizza and some chocolate this week (after I said I'd been avoiding them) to see what it does - but if I'm having them on the same day at the same meal then maybe take 3 units of insulin think I'll just stick to separate days!

 

[pawprint91]

I know what you mean but I would not say a pinch is unnecessary for all of us.
If you have little fat, pinching is still necessary. I found even a 4mm needle goes in too far for me as I am quite slim.

@pawprint91 the only additional advice is to try to come up with a pattern for your injecting to avoid always jabbing in the same place. At this stage with very small doses it won't make a huge amount of difference but over the years it can build up scar tissue which leads to delaying insulin absorption. So It is a good idea to start out how you plan to carry on.
Before I started my pump, I used to do things like use the left hand side of my body (and fingers for testing) on odd numbered dates (1st. 3rd, 5th, ... of the month) and the right side for even dates. I would inject slightly higher for breakfast, lower for lunch and lower still for dinner. I was not accurate or precise (I never had my abdomen tattooed with an "insulin map") but it encouraged me to change my spots.

How do you tell if a needle has gone in too far - and if it does, I'm guessing it doesn't damage us as such, just does something to the insulin absorption time?

Thank you - I already have a 'morning' leg and an 'evening' leg for basal - so might try for alternate sides of my stomach for now as I'm only doing one NR injection a day!

 

[helli]

How do you tell if a needle has gone in too far - and if it does, I'm guessing it doesn't damage us as such, just does something to the insulin absorption time?

For me, it hurt and bruised. It didn't overly affect my absorption time but I found it much more comfortable to pinch and inject.

 

[pawprint91]

For me, it hurt and bruised. It didn't overly affect my absorption time but I found it much more comfortable to pinch and inject.

Ahh, I wondered why sometimes I was getting bruises and it was painful and other times I wasn't (on my legs) - this could be the case for me, too! Thank you 🙂

 

[helli]

Som

Ahh, I wondered why sometimes I was getting bruises and it was painful and other times I wasn't (on my legs) - this could be the case for me, too! Thank you 🙂

There may be times when we just bruise regardless. I reported it to my DSN once and she said "some people are more susceptible to bruises." Gee thanks!

 

[littlevoice359]

I'm only 4yrs into this diabetes journey, so still a newbie! I know I'll have to deal with bruising at some point, but to try to prevent it for as long as possible, I made myself a template showing the injection sites on the abdomen and thighs for bolus and basal insulin respectively. I print those out, cut them into single slips and keep one in my diary. Then I mark off each site as I use it and, when the piece of paper is all marked up, toss it away and put in a new slip. I'm hoping this will, over time, mean that I don't favour any particular area too much and, that way, prolong the inevitable bruising issue as long as possible. The attached PDF might help you, should you choose this approach.

 

[helli]

@littlevoice359 how do you find injecting above your waist.
It is not something I have ever done - partially due to lack of fat and partially due to force of habit.
Now I have a pump, I have tried using it slightly higher to save my sites but, as I sit down a lot at work, I find my waist band rides up and the pump gets in the way.
I have injected (and positioned my pump) on my back in the little bit of spare tyre I can find. It requires a little bit of contortionism but as it is not far round, it is not too challenging.

*The internet does not believe this is a word. Pah! What does it know?

 

[littlevoice359]

I don’t find it a problem really, though it is a bit awkward I admit. I do have to pinch the skin to ensure the needle is perpendicular. Oh and I have to be sitting down and press the plunger with my thumb. Those pics I see occasionally in marketing literature showing folks using the index finger on the plunger and standing up make no sense to me…

 

[rebrascora]

Thank you for the reassurance re: basal too - just out of interest as someone who obviously has good knowledge/management of their diabetes, do you make your own decisions on your basal, or does it always have to be discussed with your team in advance?

My DAFNE course was instrumental in me having the knowledge and confidence to adjust my basal insulin and Libre makes it so much easier but I didn't get Libre until about 9 months after my DAFNE course, so there was a good bit of trial and lots of error 🙄 to get to where I am now..... but that is a good thing.... it is called experience.

I do think there is an element of the "dark arts" to adjusting basal dose and whilst there are things which might mean it needs to go up a bit or down a bit, or the time you take it needs changing, it is less empirical than carb counting to work out your bolus insulin and more intuition and previous experience in my opinion.
Adjusting your basal insulin is harder to understand than carb counting for your bolus, so it is important that the DSNs are in charge of basal doses in the first year or two whilst you get the hang of carb counting and adjusting bolus, and you still have some residual home produced insulin helping out. I am quite sure that there are people who rely on their clinicians to tell them their basal dose their whole life and others who don't realize that it needs to be adjusted and assume that their adult basal dose is set for life..... and probably struggle to manage their diabetes effectively at times as a result. When you get your basal dose right, diabetes is much easier to manage and less frustrating and these days when diabetes support is much more stretched, I think it is important for you to become the expert in your own diabetes and you are certainly the best placed person to do that once you have enough knowledge and experience.
To me basal insulin adjustment is more advanced diabetes management and you need to get comfortable and confident with the basics of injecting and carb counting and calculating boluses and corrections, before you take over that feature of your diabetes management.

 

[nonethewiser]

Injecting at angle is old advice when needles were much longer, no need to do that now with short needles like 4mm.

Tip if getting bruises with higher doses of basal, try splitting dose into 2 injection sites, it works & I found it absorbed better to.

 

[helli]

Tip if getting bruises with higher doses of basal, try splitting dose into 2 injection sites, it works & I found it absorbed better to.

I have never taken high doses (5 units is a big dose for me) and I still got bruises. I think some of us are just unlucky.

 

[pawprint91]

My DAFNE course was instrumental in me having the knowledge and confidence to adjust my basal insulin and Libre makes it so much easier but I didn't get Libre until about 9 months after my DAFNE course, so there was a good bit of trial and lots of error 🙄 to get to where I am now..... but that is a good thing.... it is called experience.


To me basal insulin adjustment is more advanced diabetes management and you need to get comfortable and confident with the basics of injecting and carb counting and calculating boluses and corrections, before you take over that feature of your diabetes management.

Ah, I think I have my DAFNE course coming up in a couple of weeks - the hospital keep referring to it as the 'foundation course', so that must be the one!
Please can I clarify - are boluses the pre-meal and corrections an additional injection afterwards if you've miscalculated the info beforehand? I don't needed corrections right now but just see the terminology a lot and now seemed a good time to check

 

[pawprint91]

Okay, so some further advice may be needed ... I had my first novorapid Weds evening, pre-meal reading was 6.5 ... 4 hours later was 6.8! I was over the moon as usually, I'd be at least a 10 4 hours after eating. However last night was not as good ... I probably had a slightly carb-ier meal (but maybe only by 10g) or so, pre-meal reading was 5.6, 4 hours later was 8.3 (this morning it was 6.9). Whilst this is by no means a 'bad reading' (especially when you've seen teen numbers come out before bed in the past week), can anybody offer any insight as to why it was that little bit higher? I had the same level of activity both evenings of pretty much just sitting around as I walked the dog before I ate. I understand obviously different food will perhaps cause your levels to react differently when you're on a fixed dose of novorapid, but could also be to do with how much time I injected before I ate (10-15 mins) or basically anything else I might be able to control?

 

[Proud to be erratic]

Hello at pawprnit91. I think you have pretty much answered your own questions; nothing wrong with that - sometimes just writing it down helps clear your thoughts.

Okay, so some further advice may be needed ... I had my first novorapid Weds evening, pre-meal reading was 6.5 ... 4 hours later was 6.8! I was over the moon as usually, I'd be at least a 10 4 hours after eating. However last night was not as good ... I probably had a slightly carb-ier meal (but maybe only by 10g) or so

Those 10 gms carbs alone could do it.

, pre-meal reading was 5.6, 4 hours later was 8.3 (this morning it was 6.9). Whilst this is by no means a 'bad reading' (especially when you've seen teen numbers come out before bed in the past week), can anybody offer any insight as to why it was that little bit higher? I had the same level of activity both evenings of pretty much just sitting around as I walked the dog before I ate.

Pretty much isn't quite exactly the same. The day's temp can affect one's BG; your level of hydration; a small amount of activity shortly after eating, eg just clearing dishes and generally tidying up for 10 mins or more; the list of small differences affecting BG feels endless.

I understand obviously different food will perhaps cause your levels to react differently when you're on a fixed dose of novorapid

Yes.

, but could also be to do with how much time I injected before I ate (10-15 mins)

Pre-bolus timing is, for me, really quite critical. I take a reading, bolus for my food plus any correction that is needed, then wait until my BG is below 7.5 BEFORE eating. If its higher then my natural inbuilt insulin resistance changes how I respond to that bolus; if its above 8.5 I might never get the corrective effect as well as the benefit of the food bolus.

or basically anything else I might be able to control?

D is complicated and confusing. I belong to a club that feels you can't 'control' D, just do the best you can to manage it. Its important to observe what is happening and learn lessons; but every day will be a bit different and I think you can only look at patterns and trends over several days - before making big changes. It's all a bit of a 'black art' managing your D, but we'll done for trying. Just take things steadily, you are running a marathon.

Have you come across the 42 factors that can affect one's BG? Do a search in this forum for more info (if I was cleverer I'd give you a direct lunk).

 

[pawprint91]

D is complicated and confusing. I belong to a club that feels you can't 'control' D, just do the best you can to manage it. Its important to observe what is happening and learn lessons; but every day will be a bit different and I think you can only look at patterns and trends over several days - before making big changes. It's all a bit of a 'black art' managing your D, but we'll done for trying. Just take things steadily, you are running a marathon.

Thank you so much for taking the time to reply in such detail to my post, I really appreciate it. I have actually just managed to get in touch with a diabetes nurse from the team and asked her advice with the weekend coming up, and she gave me really helpful advice too - of sitting and waiting and being patient rather than panicking about a knee jerk reaction to a higher reading before bed should it happen. She said to me that if the readings end up higher due to eating more carbs/the level of novorapid being fixed and don't come down, the next time I use novorapid I could maybe add in an extra unit (and if this were the case, I think I'd check my glucose levels before eating, as you advise) to correct the high level as well as to manage the food I am about to eat? (I may not have reported this correctly, but it made sense when she said it, I hope it makes sense to you too!) So between you and the nurse I have spoken to, I feel 10x more reassured about it all than I did when I first posted - thank you!

Have you come across the 42 factors that can affect one's BG? Do a search in this forum for more info (if I was cleverer I'd give you a direct lunk).

I haven't, but I will certainly be having a look now. I only know about food, exercise, illness, hydration and temperature, so a search is well needed - thank you!

Edit: Incase anybody is reading this thread and looking for these factors, I found them on this link: https://diatribe.org/42-factors-affect-blood-glucose-surprising-update
My mind is blown!

 

[rebrascora]

Please can I clarify - are boluses the pre-meal and corrections an additional injection afterwards if you've miscalculated the info beforehand?

Yes, bolus insulin is the fast 🙄 acting insulin you take to cover the food you are going to eat. Corrections are extra units of fast acting 🙄 insulin and can be added to that bolus with a view to bringing your BG back into range if it is high at that premeal reading.... or at other times when not eating to bring levels down into range.
So if your premeal reading was say 10.6 for some reason (as @Proud to be erratic has explained so well, it is not necessarily a miscalculation on your part from the previous meal but just all the variables which can throw things off) you can add a bit more insulin to the bolus dose to bring you back into range. You would usually be advised to do this once you are more confident and have a correction factor. Without that correction, if you have calculated your bolus correctly, you would still be around that level of 10 four hours later which is still above range, so not ideal.
So for me, I have a correction factor of 2 so for every unit of insulin I inject, it will drop me approx. 2 mmols, so 2 units would drop me 4mmols from 10.6 to a much better in range reading of 6.6, so I would add 2 units to my pre meal bolus injection in that situation and by the next meal I should (hopefully) be nicely back in range..... assuming my basal insulin is holding me steady.
You can also do corrections at other times when not eating but it is generally advised not to do one within 3 hours of a previous injection as that insulin will still be active (this would be referred to as stacking and can result in a hypo) because the insulin still on board may bring you down into range without you needing to inject more.

Hopefully that makes sense, but if not just ask.

PS. I have used rolling eyes emojis after "Fast acting insulin" because even Fiasp isn't exactly "fast" for me.