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They are used to present the user with relevant and tailored advertisement. You can find further information with regard to the topic of cookies in our cookie policy. You have successfully logged out. How do I rotate injection sites? Protect your skin - rotate. Protect your skin — rotate The target of site rotation is to never inject into the same spot within a short time. General rules Never use the same injection spot more than once consecutively. Place the injections centimeters apart.
Never inject close to your navel. Rotation schemes - an example. Rotation schemes — an example In cooperation with people affected by diabetes, our specialists have developed site rotation schemes for the generally favored injection areas: the abdomen and the thighs. Abdomen Start at either side of your navel. Work your injections in a line from the top to the bottom of your abdomen. Each day, you skip a little more about centimeters away from your navel and start a new line. Use the whole surface of your abdomen.
Depending on your fat layer, the last line could start almost at your flank. It should be slightly off center towards the outside of the leg. The injection should take place around 4 inches, or about the width of a hand, above the knee and the same distance from the top of the leg.
Avoid the inner thigh due to the denser network of blood vessels in that area. Though easy to access, regular injections in the thigh can sometimes cause discomfort when walking or running afterward. To administer an injection here, draw an imaginary line across the top of the buttocks between the hips. Place the needle above this line but below the waist, about halfway between the spine and the side. As with the upper arm, this site is very difficult to use for self-injection and may require another person for administration.
When injecting into the buttocks, avoid the lower part. The body absorbs insulin at different speeds from each of the sites. This information can be useful when planning insulin injections:. Inject long-acting and intermediate-acting insulin into the other sites, as rapid absorption would reduce the effectiveness of these types. Insulin works more efficiently over the entire time it needs to because of the slower absorption rate.
Exercise can increase the absorption rate of insulin. If planning a workout or physical activity, account for these when planning injections. For example, a baseball pitcher should avoid injecting into their throwing arm. The physical activity can affect the absorption of insulin into the body. Wait to for at least 45 minutes after the injection to exercise a part of the body that is near the injection site.
Avoid injecting into the same site over and over. This can irritate the skin and underlying fatty tissue. If this happens, it may increase discomfort and cause other complications. Puncturing the same point every time can lead to hard lumps or fatty deposits developing. When rotating injections, move around within the area to ensure that the injection does not always take place in exactly the same spot. For example, when taking a night time dose of long-acting insulin, a person might always feel more comfortable injecting it into the thigh.
However, they should switch between the right and left thigh each night. If a person always administers a morning dose of rapid-acting insulin into their abdomen, they should alternate between different areas of the abdomen to avoid repeated injections into the same site. Ask the doctor any questions about insulin injection, site selection and rotation, and other injection techniques.
In addition, people with diabetes should monitor their blood sugar routinely, as the doctor will advise. In our cohort, allergic reaction to adhesives was the most common complication of pump insertion reported by patients followed by bleeding, insulin leakage, bruising, discoloration and site infection.
This observation was reported before by Clausen et al. Total daily dose of insulin did not seem to correlate with LH prevalence in our study. Comparing children and adults, we found that children had higher prevalence of lipohypertrophy despite the fact that they had a lower absolute total daily dose of insulin and a comparable total daily dose per kg of weight. These observations favor the effect of trauma on development of the LH rather than the anabolic effect of insulin on the subcutaneous tissue.
Our study highlights important findings that are not confined to our cohort but can be applicable to patients with diabetes globally. In the current era of modern medicine, health care professionals might be carried away by the advanced technology at the expense of the basics rules of education.
In addition, subjective answers of questionnaire were confirmed by physical examination by trained diabetes educators.
However, it has limitations particularly in relation to the relatively small number of participants and the single-center origin of data. Our recommendations in relation to injection techniques are in concordance with the newly published multi-country survey practice implications by Kalra et al. No funding was sought to undertake the study. The Article Processing Charges were funded by the author.
All named authors meet the International Committee of Medical Journal Editors ICMJE criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Asma Deeb designed the study, collated data and wrote the manuscript. Layla Abdelrahman, Mary Tomy and Shaker Suliman collected data on demography and diabetes history, examined the study participants and performed the HbA1c.
Mariette Akle designed the questionnaire and interviewed subjects. Mike Smith advised on study design and reviewed the manuscript. Ken Strauss performed the statistical analysis and reviewed the manuscript. Enhanced Digital Features. To view enhanced digital features for this article go to National Center for Biotechnology Information , U. Journal List Diabetes Ther v. Diabetes Ther. Published online Jan 8. Author information Article notes Copyright and License information Disclaimer.
Asma Deeb, Email: ea. Corresponding author. Received Nov This article has been cited by other articles in PMC. Methods Children and adults with type 1 diabetes on insulin injection or infusion were enrolled in the study. Results One hundred sixty-nine subjects children with type 1 diabetes were enrolled; were on multiple daily injection MDI and 50 on insulin pump therapy.
Introduction A dramatic evolution is currently witnessed in advancing insulin injection and infusion devices. Frequency of needle change: at each injection, daily, longer. Results Demographic Characteristics of the Study Population One hundred four children with type 1 diabetes were enrolled in the study; 54 were on multiple daily injection MDI and 50 on insulin pump therapy.
Table 1 Study population demography. Open in a separate window. Injection and Infusion Site Rotation Thirty-nine Table 2 Injection site rotation and association with LH in adults and children. Table 3 Frequency of changing and rotating infusion set sites in children on insulin pump therapy. Skin Complications in Insulin Pump Users Allergic reaction was reported by 33 participants, bleeding by 30 and insulin leakage by Discussion It has been reported that the frequency of LH remains high and is more frequently seen in children than adults [ 3 ].
Acknowledgements We thank the participants of the study for their participation. Funding No funding was sought to undertake the study. Authorship All named authors meet the International Committee of Medical Journal Editors ICMJE criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Author Contribution Asma Deeb designed the study, collated data and wrote the manuscript.
Footnotes Enhanced Digital Features To view enhanced digital features for this article go to References 1. Guerci B, Sauvanet JP. Subcutaneous insulin: pharmacokinetic variability and glycemic variability. Diabetes Metab. New insulin delivery recommendations. Mayo Clin Proc. Worldwide injection technique questionnaire study: injecting complications and role of the professional. Partanen TM, Rissanen A. Insulin injection practices. Pract Diab Int. Strollo F, Gentile S. Comment on the new Indian injection technique recommendations: critical appraisal of the real-world implementation of the current guidelines.
Insulin-induced LH: report of a case with histopathology. Endocr J. Skin complications of insulin injections: a case presentation and a possible explanation of hypoglycaemia. Diabetes Res Clin Pract. Ginsberg B, Strauss K. Has RoboCop got diabetes? Response to Berger et al. Diabetes Care. Look D, Strauss K. Nadeln mehrfach verwenden?
Diab J. The Risk of repeated use of insulin pen needles. J Diab. Paily R. Perinephral abscess from insulin syringe reuse. Am J Med Sci. Morphology of palpably abnormal injection sites and effects on absorption of isophane NPH insulin. Diab Med. Teft G. LH: patient awareness and implications for practice.
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