This article was originally published on dLife.com—a website dedicated to helping people with diabetes live happier and healthier lives—as "Improvements on Injecting Insulin," and is reposted with permission from the author.
To manage your diabetes, do you take injections for insulin, like amylin (Symlin
), or GLP-1 receptor agonists such as liraglutide (Victoza
), or exenatide (Byetta
)? Do you have unpredictable blood sugars? You may have tried to keep your food, exercise and the amount of medicine consistent to get a grip on the numbers, but you just can't seem to.
If so, did you ever think it's because of your needle, injection site, or technique? It could be.
How you inject is important.
True, the type of insulin or other injectable medicines do make a difference. For example, rapid-acting and regular insulins are absorbed quicker than intermediate-acting and long-acting insulins, but the length of your needle and where you inject can also make a difference.
The recommended injection sites are in the abdomen, upper arms, upper thighs, and buttocks.
Human insulin (Regular and NPH) is absorbed fastest in the abdomen, being followed by your upper arms and upper thighs, and slowest in your buttocks. Insulin analogues such as the rapid-acting aspart (Novolog), glulisine (Apidra), lispro (Humalog), and long-acting detemir (Levemir) and glargine (Lantus), are absorbed across the four different sites the same.
Where your needle goes can affect how quickly (or slowly) your insulin or other medicine is absorbed.
Where there is more blood supply, there is quicker absorption. The insulin or medicine you inject was designed to be injected into your subcutaneous tissue, which is the "fatty" tissue between your skin and muscle.
There is more blood supply in your muscle than in the subcutaneous tissue. Therefore if you are not consistent in getting your needle into the subcutaneous tissue, and it gets into your muscle, your absorption time could be faster, especially if you exercise. It is important that your needle goes through your skin and into your subcutaneous tissue and not into your muscle unless your health care provider has instructed you to do so.
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We are not all the same size or have the same amount of subcutaneous tissue.
People have been told to inject into their subcutaneous tissue since the early 1920's, but it wasn't until 2010 when we learned about skin thickness (the dermis and epidermis). The new injection technique recommendations by diabetes experts say, "The thickness of the skin (epidermis and dermis) is quite constant, averaging approximately 1.9-2.4 mm (millimeter) across injection sites, ages, races, BMI and gender."
You may be able to use a smaller needle.
You may wonder, "What do the results of this study mean to me?" It means if you are 18 years or older, you can use a very small needle for subcutaneous injections and still get the medicine you need. At this time, there are several needle lengths:
I don't know about you, but most people I know would rather use a shorter needle if it is effective.
So, why do so many people still use the longer needles? Many people who have diabetes have had it a long time and get used to doing things a particular way. They were advised to use the longer needles way back then, their prescription was written that way and they continue to get the same prescription renewed over and over. Another reason could be that the health care provider isn't up on the new research or is "resistant" to it.
When it comes to shorter needles, some questioned if there would be more leakage so that a person may not get their whole dose. Research has shown there is no more leakage with the shorter needles than the longer ones.
Also, when using the shorter (4-6mm) needles, most people don't have to worry about pinching up skin. Unless you are a small child, or extremely thin, you don't have to pinch, and you should inject at a 90 angle. The new injection technique recommendations states, "4, 5, and 6 mm needles may be used by any adult patient including obese ones and do not generally require the lifting of a skin fold, particularly 4 mm needles."
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So, why do these things matter?
- People who use short needles report less pain.
- People are less fearful of the needle when they see a short needle rather than a long one. I've found it a lot easier for people to start taking insulin or injectable medicine when using a short needle because they are not as scared.
- Short needles reduce the risk of injecting into your muscle when you want to inject into your subcutaneous tissue. This can reduce your risk of hypoglycemia.
Keep your eyes open for more on little-known reasons that could be causing your blood sugar to be all over the place.
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