Insulin Injection Sites

Insulin Resistance Signs and Symptoms

1. Brain fogginess and inability to focus.
2. High blood sugar.
3. Intestinal bloating – most intestinal gas is produced from carbohydrates in the diet, mostly those that humans cannot digest and absorb.
4. Sleepiness, especially after meals.
5. Weight gain, fat storage, difficulty losing weight – for most people, excess weight is from high fat storage; the fat in IR is generally stored in and around abdominal organs in both males and females. It is currently suspected that hormones produced in that fat are a precipitating cause of insulin resistance.
6. Increased blood triglyceride levels.
7. Increased blood pressure. Many people with hypertension are either diabetic or pre-diabetic and have elevated insulin levels due to insulin resistance. One of insulin's effects is to control arterial wall tension throughout the body.
8. Increased pro-inflammatory cytokines associated with cardiovascular disease.
9. Depression. Due to the deranged metabolism resulting from insulin resistance, psychological effects, including depression, are not uncommon.
10. Acanthosis nigricans.
11. Increased hunger.

One of insulin's functions is to regulate delivery of glucose into cells to provide them with energy.[2] Insulin resistant cells cannot take in glucose, amino acids and fatty acids. Thus, glucose, fatty acids and amino acids 'leak' out of the cells. A decrease in insulin/glucagon ratio inhibits glycolysis which in turn decreases energy production. The resulting increase in blood glucose may raise levels outside the normal range and cause adverse health effects, depending on dietary conditions.[3] Certain cell types such as fat and muscle cells require insulin to absorb glucose. When these cells fail to respond adequately to circulating insulin, blood glucose levels rise. The liver helps regulate glucose levels by reducing its secretion of glucose in the presence of insulin. This normal reduction in the liver’s glucose production may not occur in people with insulin resistance.

Insulin resistance in muscle and fat cells reduces glucose uptake (and also local storage of glucose as glycogen and triglycerides, respectively), whereas insulin resistance in liver cells results in reduced glycogen synthesis and storage and also a failure to suppress glucose production and release into the blood. Insulin resistance normally refers to reduced glucose-lowering effects of insulin. However, other functions of insulin can also be affected. For example, insulin resistance in fat cells reduces the normal effects of insulin on lipids and results in reduced uptake of circulating lipids and increased hydrolysis of stored triglycerides. Increased mobilization of stored lipids in these cells elevates free fatty acids in the blood plasma. Elevated blood fatty-acid concentrations (associated with insulin resistance and diabetes mellitus Type 2), reduced muscle glucose uptake, and increased liver glucose production all contribute to elevated blood glucose levels. High plasma levels of insulin and glucose due to insulin resistance are a major component of the metabolic syndrome. If insulin resistance exists, more insulin needs to be secreted by the pancreas. If this compensatory increase does not occur, blood glucose concentrations increase and type 2 diabetes occurs.

Smart Tips for Site Rotation

Work with your doctor and track your blood glucose levels carefully when you begin practicing site rotation. Over time, you and your doctor will learn which injection sites give you the best blood glucose control at different times of day.

• Do not inject close to the belly button. The tissue there is tougher, so the insulin absorption will not be as consistent.
   
• For the same reason, do not inject close to moles or scars
   
• If you inject in the upper arm, use only the outer back area (where the most fat is). It is hard to pinch the upper arm when you are injecting yourself. Try pressing your upper arm against a wall or door.
   
• If you inject in the thigh, stay away from the inner thighs. If your thighs rub together when you walk, if might make the injection site sore.
   
• Do not inject in an area that will be exercised soon. Exercising increases blood flow, which causes long-acting insulin to be absorbed at a rate that’s faster than you need.
   
• Do not become a creature of habit! It might seem easier to find a spot that does not hurt and inject there all of the time. However, the result could be unpleasant swelling and lumps.
   
• You can reduce injection pain by choosing a needle length and gauge that are right for you.
   
• Move to a new injection site every week or two.
  • Inject in the same area of the body, making sure to move around within that area with each injection, for one or two weeks.
     
  • Then move to another area of your body and repeat the process.
     
  • Use the same area for at least a week to avoid extreme blood sugar variations.
     
• Rotate the sides (right, left) of your body where you inject within your injection sites.

If you inject insulin three or more times a day then it’s a good idea to rotate your injection sites. Injecting in the same place much of the time can cause hard lumps or extra fat deposits to develop. These lumps are not only unsightly; they can also change the way insulin is absorbed, making it more difficult to keep your blood glucose on target.
Follow these two rules for proper site rotation:

• Same general location at the same time each day.
   
• Rotate within each injection site.

Injection site rotation is important for both insulin syringe and pen users.

Same Time, Same General Location

Insulin is absorbed at different speeds depending on where you inject, so it's best to consistently use the same part of the body for each of your daily injections. For example, do not inject your lunch bolus dose in the abdomen on Monday and in the thigh on Tuesday. If you have picked the thigh for your evening injection, then continue to use the thigh for all of your evening injections.

According to Eli Lilly, the leading manufacturer of insulin, most insulin enters the blood:

• Fastest from the abdomen (stomach)
• A little slower from the arms
• Even slower from the legs
• Slowest from the buttocks

Unless your doctor has told you otherwise, it is a good idea to inject your breakfast and lunch bolus doses into the abdomen. Insulin is absorbed fastest when injected into this area. Fast absorption is needed at mealtimes to cover the carbohydrates you are about to eat.
On the other hand, your supper or bedtime dose of long-acting insulin could be injected into the thigh, buttocks, or upper arm. That's because you want the long-acting insulin to take effect gradually and cover your needs throughout the night.
If you mix two types of insulin in one shot, you can inject into the abdomen, arm, thigh, or buttocks.

Rotate Within an Injection Site

To avoid developing hard lumps and fat deposits, it is important to inject in different spots within a general part of the body.

• Change sides within an area. For example, if you inject your evening insulin in the thigh, try using the right thigh one evening, and the left thigh the next evening.
   
• You might find it useful to picture the face of a clock on your abdomen. That helps you to keep each of your injections at least one finger’s width from the last injection.
  
  Let’s say that you inject four times a day, and all of the injections are in your abdomen. Look down at your abdomen and picture “Noon” below your belly button. Place your first injection at Noon, your second injection at 1 o’clock, the third injection at 2 o’clock, and the fourth injection at 3 o’clock. You will not come back to the “Noon” spot again until day 4, which gives that spot a chance to rest. 

The most common insulin injection site is the abdomen (or stomach). The back of the upper arms, the upper buttocks or hips, and the outer side of the thighs are also used. These sites are the best to inject into for two reasons:

• They have a layer of fat just below the skin to absorb the insulin, but not many nerves - which means that injecting there will be more comfortable than injecting in other parts of your body.
   
• They make it easier to inject into the subcutaneous tissue, where insulin injection is recommended.

Depending on your body type, you'll find that certain insulin injection site work better than others.

• Some people, for example, prefer injecting in the abdomen because the insulin absorbs well there.
   
• But injecting in the abdomen isn't right for everyone, especially young children or people who are so thin and/or heavily muscled that they can't pinch up a half-inch of fat.