Now that I m finally on a full basal/bolus regime I m starting to get some serious bruising on the stomach. I inject around 5 times a day and every third injection or so leaves a bruise. You can imagine what my stomach looks like by now..The bruises take ages to heal and take on every imaginable colour before they disappear. Any tips to prevent such bruising?
The second thing is I feel like my stomach injections are getting more and more painful (I AM moving the needle around so it cant be from injecting at the same site all the time) but for some reason it really has been hurting lately. I use the same (4,5 mm) needles all the time. Sometimes it hurts so bad I cant get it in at all and have to try again at a different spot. (Profusely swearing at the needle at the same time) I inject my basal into the upper thigh which is much less painful, could I do that for bolusing too? My endo said it slows down delivery, which might add to post meal spiking...
Tipps would be greatly appreciated, thank you everybody!
i am on levemir and novorapid pens. i find the opposite, that the thighs hurt more! weird. i dont know if youre doing it the same way as me, so i dont know if this info will help. i keep away from the bellybutton, the cde said that i should make a fist over the navel and where it covers i shouldnt shoot up. i rotate the novorapid sites from stomach to the upper butt and waist área in the back. supposedly it takes longer to absorb from upper butt and lower back/waist, so i inject there when im in the 80s or i have time to wait around to eat-not very consistent site rotation but it Works for me. i use 5mm needles and always shoot up at a 90 degree angle.
my cde said the same thing about the thighs, to save them for the basal. another option might be in the upper arm?
good luck!
Thighs worked ok for me although I was taking R rather than modern insulins. The caveat there is that if you walk a lot, which I think you've mentioned, it can crank up the delivery, rather than slowing it down. Back in the days, to attack elevated post Thanksgiving appetizer BGs before dinner, I'd bolus into my leg and run up and down the stairs 10 times to get it cranked up. It seemed to work ok, although maybe it was cranking up IOB or something like that.
Juliez, can you link the bruising to a newer supply of needles? Is it possible that (i) the needle isn't changed often enough or (ii) the needles are not as sharp as they should be? It seems like my bruising is worse if the needle is dull. Other considerations include whether you inject through clothing, whether injecting into an area of higher body fat concentration, and needle gauge.
I've injected through clothing once or twice but don't like to because it dulls the needle faster (I use the same needle all day, 3-6 injections) and I can't "see" the injection site to ensure delivery. I don't have a lot of body fat so have to "pinch up" even though the needle manufacturers say it isn't necessary. As to gauge, there are 31-gauge and 32-gauge needles -- 32s are LOTS more comfortable. (It's my opinion that gauge makes a bigger difference than length.)
Speaking of length, you mentioned using a 4.5mm -- I use BD needles in both 5mm (Mini) and 4mm (Nano), and wonder what's available to you in Germany? The lower the body fat ratio, the shorter the needle needed.
Pancreaswanted provided a good tip regarding the navel area, one that not many diabetes treatment providers seem to mention -- the two-inch area around the navel is apparently quite impervious to insulin absorption. My endo at first diagnosis never told me that (learned it from an on-line video), nor did they share that insulin absorbs fastest through the stomach area and slowest through the legs and butt.
I learned somewhere to "listen to the needle" -- when lightly pressing the needle to the skin creates a tweak of pain, move to another spot (even a millimeter makes a difference) until it's comfortable. A clean, sharp needle should break the skin effortlessly and without pain.
Finally, I learned that pressing a finger to the injection site after withdrawing the needle can help minimize the bruising. When I've had a painful injection, I know for certain it will bruise -- so I try to be more mindful of finger pressure afterward.
on MDI i do levemir (basal) in upper thigh and sides of thighs and bolus in abdomen, hips, butt area and arms. I have bruises everywhere too. But, I bruise often with pump sites and CGM too. It is what it is. Use the smallest needle. I don't pinch up because I'm very thin. Sometimes some of the insulins can burn, we can hit a nerve, blood vessel, etc...which can cause bruising and bleeding, swelling. I've never noticed less absorption in the butt/hip area. I just inject where I can and try to rotate.
I had the same problem when taking up to 8 shots a day (on pump now). I also used to inject the basal in my thigh. I finally stopped reusing the syringes and did the same as Muragaki where I could tell a spot was too sensitive just by touching the syringe to the skin.
High quality needles help a lot. Some are like rusty nails compared to others. I also try to methodically rotate the injection sites. I picture my stomach like a calendar and each day of the month has its own patch of skin… Read that in one of the books, it works pretty well. I think throwing the needle into the skin real quickly like a dart helps minimize the damage too
what needles would be considered 'not high quality'? i would imagine we all have Rx's for our syringes, sold from a pharmacy, insulin syringes...we're not heroin addicts exchanging needles..ha!
A lot of people order or purhase syringes over the counter, or pen needles, because they cost less than the insurance copay. Even among name brand ones there are a wide range of prices and quality
I use BD syringes. In my experience they are of uniformly high quality. As others have mentioned here, I rotate between sites so each site gets a couple days' rest before being reused, and make the penetration very quickly. (Someone said "like throwing a dart" -- that's a perfect description.) About half the time I feel nothing at all, and the other half, a very small sting -- much less than a finger stick. Occasionally I will get a bruise; sometimes you hit a capillary and that just happens. It can't be avoided entirely, but it's fairly rare -- maybe once a month.
I wonder if maybe the shorter needles cause the bruising by putting the juice in right under the skin? I always liked the 12.7 mm (.50 cal?) needles as they were a bit longer and I don't recall hardly ever noticing any bruising. After a while, it got sort of comical trying to get them refilled as the pharmacy had moved almost entirely to the shorter ones but maybe a longer needle might be a cleaner shot, as it were?
LOL. Too funny. I have just the OPPOSITE issue. I need the shorter needles to make sure the injection stays subq and doesn't go into a muscle. I only use the 12.7s when I need to deliberately do an IM.
You need to rotate your injections from site to site and place to place as much as possible- you can inject in your hips love handles, buttocks, and that whole area on my outer upper leg/hips, under the arm, thighs any pocket of fat is fine... I find the hips and tush work best for me now.. I almost never do the stomach as that is the most painful at times.. it depends on your needles too... finer shorter needles are the best.. as for bruising my inr nurse told me if you press down on the injection site that will prevent bruising. I don't do it all the time so I'm not sure it works or not. I don't know why I bruise sometimes and not others.
I haven't really noticed that much of a difference as to absorption from site to site now.. although at first it seemed like my tummy was faster.. but I wait 20 minutes or more to eat most of the time now. I use pens and sometimes syringes with the finest shortest needles.. that should help your pain if you have finer needles...
I think technique also helps somewhat. A slow, tenuous injection is going to cause more damage. I use a swift technique and over time now get much less bruising. I like the description of the technique from Bernstein on how to give a painless injection. You just need to adapt it to pens.
In my opinion you are using the wrong needle length. Our skin is built of layers. If you happen to inject right above the next layer the insulin is trapped on top. So the insulin will be injected into a very tiny space and will create a very painful knot there. If you feel these knots your needle is just too short. In 1987 I started with syringes and they had a very long needle. The advantage was that I could use different angles for different locations. Despite of the angle the length made sure that I injected deep enough to prevent knots. Today I still use the 8mm pen needles. Of course I have tried the shorter ones. But they hurt and the shorter canal has a tendency to leak more insulin. The 8mm is exactly the compromise I was looking for. I can still inject in an angle of 45° and will get below the painful layers.
IMO, it's not the insulin getting trap, we can bruise injecting anything into our skin, every time I get blood drawn, i bruise (and I have great veins) and there is nothing being injected. i've used different cannulas for CGM and pumps (omnipod vs. MM), and typically bruise. it's the foreign object of the needle/syringe being injected, hitting whatever, causing the bruising not that the insulin is getting trapped. the knots are caused by hitting something under the skin (blood vessel, capulary), etc..
That tendency is unfortunate for sure. Thankfully I rarely hit blood vessels. But if this happens I will take a spoon to cool the location and to stop the internal bleeding. This is more helpful with pens but for blood gushers it can help too.
injecting can be very painful or not be painful at all, depends on the spot for me... by wondering around my stomach fat that i am pinching i can usually tell by how the needle tip feels against the skin whether the injection is going to be painful or not. if when the tip touch is painful i'll go for another place on the skin or a different angle to push in. i used to get bruising too but not much anymore... i am guessing the painful injections cause the bruising but not sure, and i reuse my BD 8mm 31g needles til they're weak and bend. oh and i'm not bothered by the site of my bruises... not a big deal for me for some reason.
