Intramuscular injections: Discuss

Treatment Insulin
1

This came up in another discussion, and it really intrigues/interests me. Brian reports that on the occasions he does this (sounds like it's pretty infrequent), the onset of action and the roll-off of IOB are faster.

Anyone else with experience that would share? How was the whole experience -- pain/injury at the site, the behavior of the insulin, your BG dynamics contrasted with subcutaneous, etc.?

Also, anyone with thoughts pro/con, especially with references to authoritative material please also share!

I'm a pretty tough alligator, most of the time. While my hide will probably be used for purses and shoes when I'm gone, in the mean time it can take quite a bit of pain. So if pain is the main reason IM is not used for insulin injections, but they act meaningfully faster, I'd like to give it a whirl.

2

I'm not sure what others do but since I've had Diabetes since 1961, I've needed to find more real estate through the years. About 11 years ago, I had depressions(Lipoatrophy)in my arms and lower tummy. I had been using Lispro by injection for 6 years before this happened. My arms and lower tummy were my favourite spots.

While reading up on this subject years ago, I noticed that the reports were that since the new Insulins were being used there were hardly any new cases to report. Perhaps true because many of the Endos and GPs were not checking Patients for Lipoatrophy. Also some Patients probably didn't mention the dents to their Endos or GPs because they were afraid to or didn't realize that these dents could be related to Diabetes.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322699/

http://care.diabetesjournals.org/content/24/1/174.long

Anyhowsie, that's why I experimented with more and more new injection sites. I was told to rotate injection sites when I was a Child but no one told me why(I hate when they do that). I was one to follow orders, not ask questions.

The diagram that Jag1 posted is more realistic as in areas to give injections/infusions. I actually give injections in more places than what are on the diagram. I give them in my shoulders, higher and lower in the front and side thighs, up to my rib cage(not boobs). I have severe RA thus I cannot do any back areas, so my Hubby gives me injections in most areas of my butt, in the back of my thighs(not the calves-OUCH), many areas on my back. I take an injection in muscle especially when I want to bring my BG down faster. I find different muscles lower my BG faster and some not as fast. I have used Prednisone daily for the last 9 years(off and on before that), so I need to be inventive to keep my glucose levels in a good or reasonable area.

I was 107 pounds last year until my Rheumy took me off of the MTX and Rituxan. I am grateful to be back to my normal weight(126 pounds). I have been doing this for about 10 years and I have not any muscle damage, dents and have had no hypos due to muscle injections, so far. There may come a time, who knows. I have been careful to monitor, rotate sites and I don't do "marathons"(as if, :-) ) when I'm injecting into the muscle. I am careful to do less or no exercise at that time except for normal walking at home, etc.

Oh, and many of my muscles did hurt in the beginning but not as bad now since I'm used to it. I take a deep breath. RA is waaaay more painful. We all have to do what we need to do to treat our Diabetes in a way that suits each of us best. This is one of my ways.

3

I learned about IntraMuscular (IM) injections from Bernstein. In Ch 19 of his latest book he discusses them and recommends them for corrections only. He specifically says an IM is for when you want rapid action, not for use with slower insulins (R, NPH or basal). He suggests that an IM will start to work within 10 minutes and finish at least an hour sooner than a Sub Cutaneous (SC) injection. Bernstein also says that he believes that thighs contain too little fat for SC injection and recommends SC injections on the abdomen, buttocks and back of the arm. Bernstein also shows a chart which is even more expansive than the one provided by Jag1.

For IM injecting he recommends a "standard" needle (12 mm) as opposed to a "short" (8 mm) for basal and mealtime injections. His preferred site is the deltoid. He recommends a practice of quick needle insertion (like flicking a dart) which he suggests minimizes pain. He does note that pain and bleeding are more common. While

While I would agree it hurts more, I think lancing for BS tests generally hurts more. In either case I've never gotten a deep persistent pain like you do with a vaccine, rather it is just a quick sharp momentary pain from the injection which goes away quickly.

My observation is that most advice recommends against IM injections because they are somewhat unpredictable, which I think makes them inappropriate for mealtime injections (although I will do an IM if my mealtime injection is "late"). But when you want to correct you don't really care of the insulin action is fast or really fast. Really fast is better. It is also true that you need to be conservative with correction dosing. If you are vulnerable to hypos taking an ultra fast correction that drives you hypo is really not good. If you overcorrect with an IM injection you leave yourself vulnerable to a rapid onset hypo. It is important to have a good understanding of your response to insulin and be reasonably conservative about dosing an IM correction.

4

Insulin has some normal unpredictability, when injected Intramuscular this unpredictability is increased to just plain old unpredictable.

PS: you would be hard pressed to actually give yourself a Intramuscular injection with a
typical new insulin syringe, you really need a needle longer than 1".

Typical length: From BD® CHART 1" - 1 1/2" (up to 3" for large adults)

I gave my self Intramuscular injections for 18 months, it never got easy, every time I held that syringe it felt

like I was having to stick my finger in a rat trap for the second time, over, and over, and over again. I did two

injections each day, if it had been 5-6 like like insulin injections, they would have had to put me on Prozac.

Even a alligator will run and hide after enough beat downs........

5

I'm not sure I believe this BD chart. I've had skinfold measurements taken and none of the measurements on my arms or legs were more then 10mm. The fold is double the body fat layer so the depth on my arms and legs of my bodyfat is likely less than 1/4 inch. I don't think you need such a big needle (and they recommend up to a 19 gauge needle, ouch).

6

Yes the needles I used where around 1 1/4". I stuck them in my outer thigh.
The doctor explained to me that the drug needed to be deliver center mass
where there was good blood flow.

7

Well, Diabetes itself is unpredictable with all the variables. That is why we test our BG to keep on top of it. Actually, I find accidently injecting into scar tissue more unpredictable. I only use Humalog when injecting into muscle not Levemir. I was considering switching to Novolog but I heard something on here which made me rethink that for now. Novolog also supposedly works faster. Now that would be another variable. I had to originally cut my dose down a bit when injecting into muscle. Perhaps I'd need to do that again with Novolog.

I use the 8mm syringe which works fine for me. Sometimes just when the needle is in as far as it will go, I feel this tinge of pressure/pain but I continue and it works out good with no after pain. I normally touch the needle to my skin first and I can tell if there is a nerve there? Those hurt!! I steer away from those areas.

8

Interesting feedback, everyone. Thanks.

I'm thinking of having a scoop of ice cream this weekend, deliberately under-bolus for it (calculated to send me peaking around 160 or so), then try an IM correction.

Not sure I'll have the "nothing going on" space to do it this weekend, but if I do, I'll report back, of course.

9

Followup... I tried with 8mm needles in the thinnest skin area of my thigh. 31g needle. Not sure If it went into the muscle but I think so. Tried several times.

I saw no difference in onset of action. I was sedentary, so that might have something to do with it. I'm going to try the experiment again some weekend in the next month, but this time go for a 15 minute walk afterward, stimulating lots of blood flow to the thigh. We'll see what happens then...

10

Dr B is real skinny so 1/2" probably does the trick for him. I'd be a little nervous about injecting 'center mass' regularly. I'm average build and inject into muscle (back of arms) regularly, and honestly, I don't see much difference in speed. I tried the front of my arms a few times, and got some nasty bruises though (don't any more) Also, regarding the lipoatrophy, I've been doing MDI for 2 years and am not seeing any of it. I'm also curious if it is an issue with the newer insulins and MDI.