I recently changed my Tandem infusion set just before bedtime. The infusion set had gotten crimped but I didn’t know it. I went to bed and woke up the next morning with sky high glucose. My Dexcom must have been beeping but it didn’t wake me. I wanted to get my blood sugar back down as quickly as possible, however, when I inserted the new infusion set, I thought to myself, how do I know that the new set didn’t get crimped also? After inserting the new infusion set to replace the defective one, I decided not to let the pump handle correcting the high BG. Instead, I used a pen to give myself a bolus. When I gave myself a bolus with the pen, it made me wonder this -
If you were going to administer say 10 units of Humalog, would your body absorb the insulin faster if you did 2 injections of 5 units each in 2 different injection sites, instead of injecting the full 10 units in a single site?
I thought you might get quicker absorption if the dose was split and delivered in 2 separate sites. What do you think?
I had to look this up in Bernstein’s “Diabetes Solution.” I know some don’t care for some of his dietary recommendations, but this seems to be good advice.
Research and my own experience demonstrate that the smaller your dose of insulin, the less variability you get. For type 1 adult diabetics who are not obese, we’d ideally like to see doses anywhere from ¼ unit to 6 units or at the most 7. Typically, you might take 3–5 units in a shot. At these lower doses, the uncertainty of absorption approaches zero, so that there is no need to worry about whether you should inject in your arm or abdomen or buttock. I have a very obese patient who requires 27 units of long-acting insulin at bedtime. He’s so insulin-resistant that there’s no way to keep his blood sugar under control without this massive dose. In order to ameliorate the unpredictability of large doses, he splits his bedtime insulin into four small shots given into four separate sites using the same disposable syringe. As a rule, I recommend that a single insulin injection not exceed 7 units for adults and proportionally less for children, depending on their weight.
Chapter 7, “The Laws of Small Numbers,” page 112
That advice sounds reasonable regarding the full absorption of a dose. I’m also wondering about whether the rate of absorption would be quicker with 2 split doses vs. a single dose of the full amount, which I think is a little different from the issue of obtaining full absorption.
If you really need faster absorption go inter muscular rather than subcutaneous. I know of some type 1s who will do that when BG is very high for whatever reason.
The fastest insulin I know of is Afrezza inhaled insulin. I have never used it, some have needle phobias, for me it is stuff up my nose. Go figure.
I use a Tslimx2 pump so when dosing a larger dose as for pizza, I do an extended bolus, anywhere from a short 25 minutes to the full 2 hours. Serves the same purpose as separate small boluses.
This is an EXCELLENT IDEA. Been a pump user since 1998. I adopted this method years ago. I rarely need to use injections, but when I do, I split into equal amounts (4 units insulin per site), filling the syringe to total needed, prep skin areas with alcohol pads. Works great. Best to use sites in abdomen away from normally used areas.
