I've been trying expand the areas where I inject insulin for my MDI regime. The big problem I am having is my basal injections which I take in the morning and night. My arms and legs have very little body fat, so I've been exploring using my buttox (gluteal region). But I've been struggling.
You are supposed to use the upper outer quadrants as shown to the right. My problem is that I find it not only cumbersome to use a pen in the proper orientation for that location, but I can't for the life of me pinch an inch. What do others do? Do you back yourself into a door jam to create a pinch? I wonder whether an autoinjector would help. Has anyone used one? I've also read that the best absorption seems to be in the abdomen followed by the thighs and then the buttox, but mine seems to be the opposite. What is your experience with absorption? What has your experience been with Gluteal Self-Injection
I use a pen with a 4mm needle and, per the instructions for that needle length, I don't pinch up any skin regardless of where I'm injecting. That removes at least one complication for some locations.
I don't think that picture is accurate - I know it comes from BD but is surprisingly limited. According to some of your previous posts your BMI is around 25, in which case you should have a much larger available real estate than that picture shows. I think only very thin people (especially children) need to be concerned about not having sufficient subcutaneous fat to make an injection.
My BMI is substantially less and I have used areas far outside those shown in your picture without any problems. I do always pinch up my skin, but that is probably habit more than anything else, from learning 40 years ago with much larger and longer needles. If you do manage to inject into your muscle you will know it (painful). Try using the following picture instead:
Why don't you just put the needle somewhere in your buttocks, regardless where. i have never heard to put it in you "upper outer quadrants" WTF, lol. i dont even know where that is, haha. there is enough fat, at least on mine, to inject wherever i want there. without a pinch. actually, i found out that they now teach you not to make a pinch anymore anyways, since that is not of much use. i do not pinch my arm either when i inject there.
lol, those were my thoughts also, I have a lot of fat there, so I just do it anywhere in the tush! My main problem with that area is it hurts my back /neck because I have to twist in a funny way to do it and it is also more painful sometimes. I never pinch to inject anywhere anymore. I don't do my stomach too much anymore unless I want to come down fast, because it often hurts too much and is too rapid. My fav area is the outer hips/legs, this is the least painful for me. Anywhere you have a little area of fat is fine. I haven't noticed significant difference in absorption except the stomach is faster, but I'm not sitting there timing things because there are just too many variables to tell for sure what is going on. I use very fine short(.23 x 4mm) pen needles and syringes. The syringes are a little longer and usually don't hurt at all, depending on the area, but I have to insert them slowly & at the right angle sometimes a diagonal sometimes straight.
I may well have additional real estate available. My experience with using my arms and thighs has been a repeated disaster, I always get an intramuscular injection, it is painful, it bleeds and I can tell from the action of the insulin that it went into muscle. The picture you show details the use of the lower buttox which I have heard should be avoided because of the danger of hitting the sciatica nerve. It may be that using a 4mm needle helps, I may try that.
I pinch. I kept having problems with injecting in my abdomen where I apparently stabbed the abdominal wall and the injection was blocked. Pinching gives me enough flesh that I don't have blockage. Maybe I have enough fat, but at this point since absorption seems to be about double on my buttox, I'm a little worried that I'm just injecting into muscle.
Actually maybe I pinch with a syringe for my stomach only though. I think you just need to do whatever works best for you. Do you mean double in twice as fast? I thought muscle injections were faster? I guess you could be injecting into the muscle. I find it feels a little harder sometimes and hurts so that is why sometimes I wonder if it is in the muscle a bit, however it doesn't hurt the way a vaccine or another shot truly injected into the shoulder feels- hurts me a lot. I have never noticed it was faster, but I have too many variables and changes to tell. I notice novolog usually peaks around 30-40 minutes for me at which point I drop very fast, but it can drop me low much quicker than that which is why I sometimes don't pre-bolus at all or for a short period depending on bg, how I feel, food eaten during the day and exercise before etc.
If you haven't injected at a diagonal in the stomach I would try that to see if it helps.
On the occasions that I correct a high blood sugar I do an intramuscular injection into my quads. It is fast. I've been rotating my basal injection and using my buttox seems to require at least 25% lower dosing to get the same effect, I've not noticed a shortening of the duration although that may be happening.
I've tried injecting diagonal and it works well, but only with a pinch.
I think I may just need practice. Using less insulin isn't necessarily a bad thing, particularly if it lets me rotate sites. I just need to make sure I dose properly and avoid hypos.
I would just pinch an inch and give yourself injections where ever you have some fat on your body. I read that you are supposed to inject with the shortest needle possible close to the skin. When I was in the hospital they injected the needle at a slant. It hurt like hell and left terrible bruises. Then the nurse practitioner told me that I was supposed to use the shortest needle possible. I have long ones so I have been trying to back off a bit when I inject and get the shot closer to the surface. If I did the areas it shows in your picture I would have problems as I have no fat there either. I would just shoot it lower in the butt area! You can do it if you miss the muscle and hit the fat.
Just get 4mm needles if you use a pen, no need to pinch and it's a 1 hand operation. I don't know how possible this would be with a syringe , but with a pen it is pretty easy. What I do is take the supplies in the bathroom, use the mirror, just center it over the top part of my butt to where it'll go in at a 90 degree angle then inject. I wouldn't want to use a pump or syringe there as it's a very difficult thing to do without a pen that has a 4mm needle. For me , butt and thigh=best places for lantus, though I find with my thighs I can't do it all of the time and sometimes using my butt is better and more likely to avoid hitting a spot that's gonna bleed a lot or be painful as I don't have a ton of fat on my thighs .
i use the 5mm needles so i dont have to pinch. i originally started using them on my arms, but for those hard to get to back places, theyre fab! on my arms, i use a door frame to pinch-watched the happy diabetics youtube how to-but for the bum or love handle area i dont pinch. good luck!
I can tell from the action of the insulin that it went into muscle
Brian, would you mind elaborating on this a bit?
I've never had that happen (knock on wood), and would really like to know what "signs" to look out for (other than obvious pain you mentioned -- I'm thinking more the "diabetic" things).
I've only tried the arm a few times, it has been very difficult to pinch. I can tell from the action time. I use my quads for corrections (on purpose) and based on tests the insulin acts quickly and wears off much faster. Spots of blood are routine, something I get infrequently in my abdomen.
I've been told and read that it's a good idea to stay 2" or more away from the BB because of absorption issues. Presumably there's more connective tissue or something around that (long unused) connection.
oh, for some reason I thought you were trying to avoid the muscle, then my advice won't be useful I guess, lol. I have never intentionally injected into a muscle since I don't want to drop so fast. That is odd you have better absorption there, but good that you figured it out. Practice should help!
