Insulin injections

I am new to insulin injections using Lantus Solostar and Novolog Pen. My doses are low (about 3 units Lantus, 1 to 3 units Novolog). I have bruises and bleed often. I rotate my spots (abdomen, love handles, outer thighs, back of thighs, bat wings of arms); still I bleed and bruise more often than not. What am I doing wrong? Does the "cold" insulin from the refrigerator or FRIO case cause the bleeding and bruising?

Truly would be appreciative of helpful suggestions and experiences.

I started Lantus SoloStar in May of this year, so still pretty new to it. I use it once before bed, 18 units. I was told to inject it around my belly button since that is very close to the pancreas and you want to get it as close as you can. Dont use it straight out of the fridge, it can sit out at room temp for 28 days. Let a new pen warm up before using it.

I dont have bruises nor do I bleed so I really dont know why you do.

Were you told to inject in all those other places?

Actually it doesn't matter how close to your pancreas you inject, the Lantus is injected into the bodyfat layer and then released into your body via the small blood vessels in the bodyfat layer. In fact, you want to specifically avoid your belly button because most people have inadequate fat in that immediate area and you are more likely to hit the wrong kind of tissue.

Bleeding and bruising are often a sign of misinjection. If you pinch up better and quickly get the needle in (one recommendation is to think of insertion as throwing a dart). Some people also find that different needle sizes help. There is a "nano" needle that is 4mm and most people find they do not need to pinch with that needle.

about the 28 days after opening.....does that apply to insulin that has not been opened but carried in a FRIO container? I had to go on a trip and carried extra insulin in a FRIO container and that one has not been opened and was refrigerated except for the time in transit (approximately 12 hours). It would seem wasteful to throw it away.

If you just had your unopened Lantus pen in a frio for 12 hours it probably is fine. Just put it back in the fridge and then when you open it, it will likely be good got the 28 days after opening.

They say the lantus is good for 28 days after opening and that prior to opening should be refrigerated— where it becomes unclear to me is how time spent unrefrigerated prior to opening will affect shelf life at room temperature once opened— this is what has kept me from ordering from mail order pharmacies (which is probably foolish because obviously it has to be shipped from somewhere to my local pharmacy)… I’ve talked to pharmacy techs for some of the international mail order pharmacies (18 day shipping to clear customs) who have stated that up to 28 days unrefrigerated before opening will not affect the 28 day life after opening and that they’ve been shipping it like this for years to thousands of customers— I still can’t convince myself sitting in a box for 18 days at totally uncontrolled temperatures isn’t going to have any affect so I don’t order from them.

Per ADA— “if you inject in the abdomen do not inject near the navel…”

Every other source I’ve ever seen days the same

Here the manufacturers of lantus specifically state not to use within 2 inches of navel

Thanks for your comment. I can only go by what the DE told me, which is to inject in a 1" circle around your belly button, not into your belly button. I get a few inches away from my belly button most of the time. It rarely hurts, and if it does it's just for a second or two. I have the smallest needle there is, mainly because I am a wimp!

I’ve found that high quality needles make a big difference too… I bought a ton of cheap generic ones and they feel like rusty nails compared to my prescription novo fine

I think your DE may have meant not to get closer than 1" to your belly button, rather than meaning to always inject in a circle around your belly button. If you don't rotate to sites other than that small area you can develop lipohypertrophy, which is a fatty lump which can grow quite large:

Yeah something doesn’t make sense about what she told you… That’s like rule #1 about injecting insulin I am wondering if she misspoke or was misunderstood…

I seem to only need 1 to 2 units when I eat a low carb meal about 15 to 30g. Any suggestions or recommendations about needle,pen or vial and personal anecdotes about Apidra or Novolog? I realize that diabetes is very personal, and everyone reacts differently. The Novolog "fast" meal time insulin, doesn't seem fast. 1 or 2 hours post meal blood sugars are higher than 140; after 2 hours drops down to 110 and 3 or 4 hours may be 85 to 90. The insulin peak and the blood sugar peak seem difficult to match.

Also, anyone in New York City, Manhattan who can recommend an experienced doctor who specializes in diabetes? From what I've heard from some diabetics, some endocrinologists' knowledge are "by the book" and not based on experience and diabetes may not be their specialty.

I don't live in NYC, but endocrinologists ARE truly the best option for diabetes management. Look at your nearest hospital/medical center, look into the doctors there, google them and research.

Is it ok to leave the insulin at room temperature once the vial or the pen has been "used" or punctured? I have heard that cold insulin can hurt.

I dont recall her exact words but it was something like inject around the area of the belly button, but not into it. That would surely hurt! She did not say dont get closer than 1" to your belly button. I remember her balling up her first and putting it on her belly button and saying the pancreas is pretty much behind there.

I inject 3-4 inches from my belly button, all around it, in a circle more or less. I dont have any fatty lumps.

Yeah with vials and pens you can leave them out of the fridge once you open them. Typically for 28 days , though I think Levemir can be left out for 42. Unopened needs to stay in the fridge as it'd expire after that point if refrigerated. Keeping unopened insulin in the fridge makes it last for until it's expiration date on the vial or pen... unless it gets frozen or something.

Is there any purpose in refrigerating opened pens and vials?

my bruising and bleeding is mostly from the novolog pen; not so much from the lantus solostar.

I'm no expert of human physiology but I've gotten better over the years of avoiding blood vessels. I still get surprised every once in a while. I've found that nerves seem to be near blood vessels. If any injection is painful, it often bleeds. I remove infusion set insertions that are painful, careful to have some tissues nearby. Avoid the spots that provide more sensation when palpitating.

Your pen needles are probably a very fine gauge and only 3 or 4mm deep.

Insulin taken from a refrigerator can hurt more when injected but I find that the Frio temperature is not painful.

After another 10,000 sticks, giving an injection will be a forgettable non-event!