Injection techniques

I was diagnosed type 1 in June and am trying to learn the best, most efficient method for injection. I use the pens not a syringe. I am quite lean right now which I’m happy about but it makes finding plentiful injection sites rather challenging. I just want to get a method down where I can know where to inject and be able to do so painlessly and without bleeding and subsuquently bruising etc. The beginning was a disaster because I just didn’t know what I was doing. The ditzy “educator” sleepwalked her way through having me stab myself in the upper arm and sent me on my way. I doubt stabbing an orange would have helped much either. So in the beginning I was stabbing into muscle and bleeding and bruising like crazy, not helping me gain confidence or helping me relax at all. At first I just was not into injecting in the abdomen so I was trying everywhere else. Then I convinced myself to try the abdomen and it went well for a while. I had a streak where I was doing OK with the injections and thought I finally had mastered this art. Then I started having botched injections and the confidence level started to subside and I’m back in a slump. The mindset seems to have an impact too. Now staring at the site waiting for impending doom I kind of freeze for a moment. I’ve blogged with numerous people about how they do it and this might be something I just have to learn on my own with doing it over and over and over. Just wondering how long that will take. I’m just curious on some input, I know it will vary because I’ve blogged with people and it goes from -you have to throw the needle in rapidly-I push it up against the skin and penetrate slowly-i pinch and pull the skin away-i don’t pinch, it works better that way and so on and so forth. So far the injecting has been the most frustrating thing to deal with, I’ve kept my numbers in check, the finger pricks I’ve gotten used to. It will be a relief when I can do these injections without it being such a burden. It naturally bums me out too when you’re saying to yourself-OK I’m going to do this and it’s going to be OK and I’m going to understand how to do this. Then I stab myself inducing a stinging similar to a bee sting, then i await the pulling out of the needle bringing on the bleeding. Next hold swab against site for a few minutes and hope for as little damage as possible. Undoubtedly a yellowish green bruise will be around the corner. Any advice would be much appreciated. Thanks.

how big are your needles? I am fairly slim and I find that anything over 6mm bruises and stings and hits muscles and results in subsequent problems, but anything under 6mm the insulin leaks out and results in “unexplainable” highs. I don’t do a skin pinch either - insulin always leaks out when I do a skin pinch.

I am with you there, I have been injecting for 3 years and I still end up with nasty bruises. I look like someone has beat the crap out of my stomach 90% of the time. I have tried thighs as well and my thighs tend to bruise worse than stomach. Right now I am trying out the i-port for another month and see how it goes. It is one injection every 3 days compared to the 7 I do a day on a good day. I also go through periods where for some reason I get terrified to inject myself and I just freeze up. I learned how to inject myself when I was hospitalized, the nurse walked in and handed me the insulin and syringe, told me to draw it up and inject myself. Didn’t bother to tell me how to do it or anything . I was shaking so bad the first time I did it. I have just learned to deal with the bruising as nothing seems to work for me. I have had nurses freak out before over bruising on my stomach it has been so bad, to me it is just a part of being a diabetic.
Good luck in finding a way that works for you.

Try the 90 degree rule - straight in, straight out.

I don’t inject anymore and I’m pretty thin. If you’re using a pen, the needles are probably pretty thin also. My technique never left bruises, but it may just be that you bruise easily. I’d occasionally get a drop of blood but not often.

My technique was/is to gather a bunch of skin between thumb and forefinger. Not a lot, just a comfortable amount without pinching. Jab the needle in quickly at a 90 degree angle all the way in. Inject, pause (one - two - three), pull the needle STRAIGHT OUT at 90 degrees and release the skin.

It’s important to remove the needle at the same angle as it went in. This is why the 90 degree rule works without leaving bruises. My experience was that I only bruised when the needle moved around or exited at an angle.

I pinch but keep the needle in for a few seconds while i release the pinch before pulling out the needle.

Thanks for the input Emma. I use what I think is the smallest needle out there the BD mini. It is 5 mm(3/16) and 31 gauge. When I got diagnosed and sent on my way with my bag of supplies I got a bunch of free sample pen needles that were 8mm (5/16) and 30 gauge. That is what I used first (the scrip they wrote for me was the BD minis but I didn’t know the difference until I picked up my first scrip for a box of needles and saw the difference) and it was a disaster all the time. Like you said anything larger than a 6mm needle for someone with my body fat is too long COMPOUNDED by the fact I had NO idea what I was doing. When I got my first real box of needles from the pharmacy (like I said at first I just used the free ones) I saw it was the minis and how small they were I said ,“Oh no wonder. NOW I’ll be fine, look how small these needles are!”. Well, not quite. Still problematic. I do deal with leakage all the time which is frustrating. I do pinch though, which is one of the reasons I’m sure of the leakage. Sometimes I try pinch, inject, hold and then slowly release allowing the injection to go deeper for a second then pull the needle out. I think that, though, sometimes wil bring the needle too deep and hit muscle. I’m terrified of doing a “no pinch” injection even though these needles advertise themselves as “no need to pinch up” needles. I don’t know. I blooged with a guy on diabetes daily who just started injecting and doesn’t pinch and said it works great. No leakage, no bruising. I’ll have to try it sometime when I’m brave, it’s just that I’ve had all this trouble with the pinching up I’m afraid to think of what would happen without. Where do you inject with no pinch?And do you do a rapid stick with the needle? I’m seriously thinking about looking in the Exubera to eliminate as many injections as possible if this keeps up. Then I’d just have one basal to take. I can’t deal with 4 times a day of this.

I don’t bother with the pinch anymore. I use the mini needles also, since I’m thin. I inject straight in at a 90 degree angle and I rarely get bruises. I’ve only got a drop of blood a couple of times. Sometimes, the insulin burns as it goes in, don’t know what that’s about. I think that might be when I hit a nerve? I get little red pinprick marks on my stomach but I only have one bruise at the moment. I inject above or below my belly button, making sure I’m at least 2 inches away, all the way out to the side of my waist. I use the diagram in Dr. Bernstein’s book and my endo also told me this was OK.

I use needles too but was on syringes for 14 years. I go in at an angle as well but I make sure it isn’t muscle. It isn’t easy as I’m a pretty tone guy and slim. But at the same time for me, having my muscles defined lets me know where not to poke. I do about 90% of my injections in my arm.

I do it in between my triceps and my shoulder muscle where there is more fat. Of course though the best place on the arm is really the underarm on the other side of the triceps.

I use my knee/leg to pinch up from the backside and that makes it easy for me. I know reading this doesn’t give the clearest explanation :-\

Don I’m so sorry but you ask me that on my page and between computer glitches and surgry I didn’t get back with an answer. I learned how to give myself shots with a syringe when I took D my daughter also learned that way too with the alacohl and all I now am a pumper and have been for 20 years so my advice is probably not the best but I have always when using a syringe or pen went in really fast diatribeted the insulin then pulled the needle out wiped it with the prep pad and let the bruses come if they wanted to. Chin up they didn’t leave scars like the pump has on me anyway. Everybody else has said something about the 90 degree rule that’s one to always remember. Also since your kinda new to this you will bruse a little easier than you will after you get used to it and so does your skin.

I thought I’d recommend checking out these videos by Dr. Bernstein, where he demonstrates some injection techniques on himself:
http://tudiabetes.com/profiles/blog/show?id=583967%3ABlogPost%3A2341

Don,

I have found that if I just gently nudge the skin with the needle before injecting and feel anything, I should move to another spot. Most of my injections don’t hurt at all. In fact, I often can’t tell if I’m in without looking.

I also found that I do best on my upper front thigh though if you are skinny that might not work. Us ladies have padding there.

On the tummy I have to stay pretty near the belly button or I get huge hideous bruises.

I do pinch.

I started out using Dr. Bernstein’s “throw it like a dart” technique which was extremely helpful in getting over the terror of self injection, but now that I’m 2 years in, I just lightly touch the surface to check for nerves and then push.

One last note: I MUCH prefer syringes to pens. I use a Novolog in pen when I’m in a restaurant because it doesn’t look so Junkie, but at home I use R and syringe and even though the needles are supposedly the same guage, I think the syringe needles are a bit easier for some reason.

I use the BD mini syringes and inject at a 45 degree angle into belly fat that doesn’t hurt when I poke the needle at it (few nerve endings). Sometimes I pinch, sometimes I don’t; it all depends on where I’m injecting (further towards the sides I need to pinch, below my bellybutton I can get by without.) The 45 degree angle has reduced leakage to nearly nil. It might also help that I don’t inject more than 7 or 8 units into a single site: Bernstein again…

A while back I hit a vein or something on my arm and was bruised for well over a month (in fact there’s still a shadow on my skin there). I don’t use my arms or legs any more; the insulin doesn’t deploy as well and it’s easier to bruise them.

I agree with the notes that others have said about making sure you use a needle that is the right length. Shorter syringes and pen needles tend to work better in people who do not have excessive adipose tissue, and may also work better depending on the injection site as well. Also, keeping the needle in the skin for a few seconds after finishing the injection will help to ensure insulin does not “leak” out of the injection site. Note that bruising will occasionally occur in most people because you are injecting yourself, and do not have the benefit that a nurse or doctor has when giving an injection to a patient as far as angle and approach. Unfortunately, some educators and doctors do not advise their patients that shorter needles are even available, but you may ask your pharmacist what sizes they sell, and then ask your doctor for a script for the specific type you feel will fit best.

I use the Humalog and Lantus Pens and the drugstore didn’t have my regular needles and sent me the minis…I noticed that my numbers have been considerably higher since using then…I am still a little ‘zoftic’ (but working on it!) and wonder if any of you out there have had the same experience…I’ve been injecting in my stomach, but have changed to my thigh which is thin and muscular.

rotate your shots thoroughly. That is, try to get a pattern, routine, so that you can avoid saturating any given area with too many shots.

there are more good injection sites than you might think. The first 30 or so years that I was diabetic, animal-source insulin was all there was, and you had to strictly observe the rule that ‘no second shot within an inch of a previous shot for two weeks’.

If you are not only lean but ‘muscularly developed’, the trick is to avoid the very thin skin over ‘ripped’ muscle. Your buttocks have lots of square inches. You don’t need both hands if there is any ‘slack skin’, just reach around and jab. I give shots in pectorals, on the rib cage, as far as I can reach around the lats, butt, backs of thighs, inside of thighs (I avoid the top of the thighs except very high near the groin, and not on the outside of the thighs-- too much muscle in those places, and too close to the surface). I shoot in stomach, as low as feels comfortable and as high as the rib line. I avoid the midline, the vertical line through the navel. When there are other folks around, which is very rare for me, I will get them to give me an injection ON the back. Anywhere you can get some slack skin is a good injection site.

You are early in your game… when you go ‘prospecting’ into unused sites, you will find that the insulin uptakes very much faster and very much more strongly in never-used areas than in areas where you have given a few shots already.

Arms I use sparingly. Sometimes it helps to use the edge of a door or some such to ‘lift’ the tissue on the back of the arms, since you can only use one hand.

You have the right idea with not ‘pinching’ skin. It is far more effective to just ‘lift’ the skin a tad with very wide-spread fingers where you have to lift at all. I shoot in many places where it simply isn’t possible to get your second hand in place to pinch or lift at all.

I do not even attempt to ‘sneak the needle in’. I jab. And I find that whether or not you bleed depends on whether or not you hit a surface vein, and I find that is simply the luck of the draw. Perhaps one in 20 injections I will get a bleeder.

You CAN do it, and it WILL be ok.

I don’t suggest that you ‘get fat’ to make shooting easier, but being excessively lean, particularly when hard, toned muscle is underneath the ‘lean skin’ IS a complicating factor.

Hey Don,

I had a terrible time with pain & bruising with pens. My first endo gave me pens free. Using syringes, I have no problem. Thin, narrow needles (I’m thin), no leaking, no pain, no stinging. I use the pinch technique–bunch up a bit of flesh, inject at 90 degrees, hold in for a few seconds, release pinch, pull needle straight out. Don’t feel it at all. I use my stomach, thighs & the upper butt pretzel twist (whatever I can reach) & rotate. Tried my arms once–ouch!