this is a really critical topic!
I’ve been a type 1 for over 15 years with excellent diabetes management (5,8-6,0 HbA1C) but last year started having enourmous problems with controlling my sugar levels. High doses of insulin did not work and sudden drops with limited or almost no insulin injection started. I lost consciousness for the first time in my life. Nothing made sense. We started monitoring the situation with a great medical team of endocrynologists and diabetologists who all got direct access via cloud to my libre system. We followed with extensive tests in a strict controlled environment of a university hospital to figure out what the hell was going on. I have never been tested so much in my life (i guess i was an interesting test subject). we all went through enourmous amount of literature in english, french and italian and literally started testing for diseases which occur in 1 to 30 mln people to find some sort of explanation (weird lung tumors, insulinomas, etc). It seemed like a ‘dr house’ type of situation.
After crossing all of them out we have returned to square one. The insulin was ok, the equipment was ok, I was ok (by all measurable medical standards), so what the hell was wrong? The last thing we started checking was the skin/tissue and injection sites.
We were all quite smart about diabetes (uni hospital full of professors and experts in the fiedl), I have never seen a difference in absorption rates depending on an particular body zone injection site or needle lenght, i am fairly slim and have a hardly detectable lypohypertrophy. But yet - the needles, injection sites and that limited lypo proved to be the source of all problems. Once we changed the needles and injection sites - all returned to normall.
Really little attention is given to injection sites control, needle length/reuse and injection technique. Maybe beacuse this is a slowly growing problem which doesn’t manifest immediately. It also isn’t anybody’s exact domain - this area lies somewhere inbetween the key knowledge of a nurse, a diabetologist, a physiosterapist and dermatologist. And let me be clear - this issue can absolutely destroy your feeling of self confidence in diabetes control.
If you are still injecting with 8mm needle (i did for many years) please go to fit4diabetes.com. This is a great initiative which based on scientific data explains in detail how to inject insulin, what type of needles to use and how to avoid unfortunate consequences of doing it wrong. And 8mm needle or longer - it is a mistake!
Some useful shortcuts: