12 mm pen needles are certainly made by a number of manufacturers including BD. As to whether your local pharmacy is another question, but at least around me they are widely available including at Walmart.
I use a pen and inject into my quad muscle which has a small body fat layer. I just jab the pen perpendicular into my leg. I can then also walk around increasing the rate of absorption. Others suggest using the deltoid muscle on the shoulder as it also has a minimal layer of body fat.
Dr. Bernstein's Diabetes Solution in chapter 9 discusses the use of intramuscular injections for fast corrections. I think IM is a good thing to have in your toolbox but it should be used with respect. If you have a tendency to over correct you need be very careful, this technique will result in a faster action profile and less opportunity to deal with a serious low.
Yes... as I'm finding, I have to use different, more sensitive parameters (ISF in particular) to avoid lows.
Corrected another one this morning (fell off the wagon last night and snacked badly before bed), but tried with an ISF 50% more than what's programmed into my pump.
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BG nose-dived as expected, quickly. 210 came all the way down to mid 90s in about 90 minutes, then glided to flat (93 as I type this). So, missed "target" by about 10 mg/dl -- good enough for me.
I'm experiemting with this all weekend. I'm also going to try an IM meal bolus for a high glycemic, high (for me) carb load meal at lunch. Going to apply the same 50% increase in my IC for dosing purposes, and see what happens.
Should be interesting!
Thanks Brian, I wasn't sure they were made since I don't use them.
I use the deltoid, for the reasons given. Like Brian, I also exercise the muscle afterward to enhance absorption. Both the quad and the deltoid are good choices, and effective. Let your personal preference guide you.
The point about overcorrecting is significant too. Since an IM does take hold sooner, work faster, and peak earlier, that is something to be aware of.
There is also another, much more subtle and less immediate danger. If you find yourself using IMs more and more frequently as time goes by, it could (possibly) be a clue that you are correcting too often, i.e., being lazy about bolusing because you know you can always correct later. (Of course, it can also mean you are just becoming more comfortable using them, and nothing more than that. Some introspection is always a good thing.)
All of that said, IMs are a very useful tool to have available when needed. Used properly, they can significantly enhance control.
So, for example, if 1 unit of correction insulin delivered sub-q drops your BG by 40, then you might figure your IM correction to 1 unit dropping your BG by 60. Is that correct?
It'll be interesting to see if this holds true over time.
That's it!
Both the quad and the deltoid are good choices, and effective
Indeed, and for (at least) two reasons: Very thin subq fat layer so easy to get good muscle penetration; second is that, even if you don't deliberately exercise the muscles, they get used a lot naturally -- particularly the deltoids. I'm thinking the delts are a better choice, because they're basically active constantly unless you're asleep.
I've used them before a few times, and never had an issue. Used my right delt this morning for my correction, and it hurt like the dickens. Had to pull the needle and give the rest (about half) in my quad. Strange...
I wouldn't attach much significance to that. In my experience, variability in the comfort level just goes with the territory, even with subQ injections. Sometimes there is no sensation at all, and other times they sting quite a bit. Why? Who knows? As a very smart endo once said to a friend of mine, if you can figure out the "why" in ten seconds or less, fine. Otherwise just correct and move on.
Yeah, it was an unusual, and weird pain. I think I nicked a nerve or small artery or something. It was that deep muscle, achy sort of pain, but sharp and strong. Strong enough I couldn't continue there and pulled.
Different pain sensation, though, than when a subq bites back...
I found a 1/2 inch needle in my kit and delivered an IM shot at 7:50 a.m.to my deltoid. It had a great effect:
Green strip is 65-140 mg/dl.
I always refer to the 1/2" needles as .50 caliber as it makes it more fun!!
I believe that your getting faster results from IM, but ouch! Gonna take more data than that before I move to .50 caliber. Might blow my own head off on accident. You guys are fiercer lab rats than I! Good to have you around. Your nuts!
Welcome to the club, Terry!
Nuts? Naaaaaaaahhhhhh!
Like anything else, unfamiliarity breeds caution. I was pretty careful at first, 'cause I had no data to go on for how it all would work.
I've been doing IMs now for at least a month, and am almost familiar with how my body reacts as to subQ administration. I've done it enough that the extra work to do IOB accounting and manage it has become simple and fast. I use Glucosurfer on my Android smartphone.
Word of warning: If you're a pumper, IM injections will render your pump's IOB accounting for boluses worthless. You have to go the extra step and manage all bolus insulin dosing from an external source -- smartphone app, paper and pen, whatever works for you. This also means you can not use the pump to calculate correction boluses either -- that will have to be done "manually" as well, although Glucosurfer handles it for you (one of the reasons I'm using it).
After all your IOB clears, you can go back to the pump tech again for managing IOB -- provided you don't do another IM.
All that said, after I got used to the differences in the routine, I don't find the difference to be much extra work at all.
In a coupla years when the new ultra fast-acting insulins reach the market it will be interesting to see what an IM injection with that stuff does :-)
By 'nuts,' I mean 'tough.' Your hardcore. I'm pretty needle shy, though. It takes five of Saint Paul's finest to give me an IV of Dextrose.
I have never used the IOB on the pump. I always calculate on paper because I'm just not familiar with the algorithm they use to calculate IOB. I'll look it up now....thanks. Exciting events to come!
Curious about something, boys. I don't think I see a manual Injection correction start to take effect for several hours. This might be slower still with a pump, yes? I tend to inject into fatty sites, though. I gotta look at my data more closely...
I started using IMs very early on, after reading Bernstein cover to cover several times. He is a big proponent of IMs and explains them quite cogently. I began using them when indicated and have never had a ghost of a problem. Like anything else concerning diabetes, do the homework, know what you're doing, test as needed, and the results are likely to be just what you're looking for. FAIL to do that due diligence and . . . well. You know the rest.
Too many variables to give a direct answer. What type of insulin? How long as it been open? What injection site? What did you eat? Have you validated your ratios recently? etc.
I can only report my own data. For an "ordinary", i.e., subQ injection, Apidra starts working in 15 minutes, Novolog in about half an hour, Regular in 45 minutes. An IM (always Apidra) cuts that by a third to a half.
Still reading 'Think like a Pancreas' and 'Pumping with Insulin.' I guess I haven't purchased Bernstein. Thanks for reminder. Humalog correction with no food. < 1 mo. opened. Generally injecting around the middle - hips, tummy, and butt.