Johns Hopkins Health Alerts | Diabetes | How Injection Site Rotation Can Help You Control Your Diabetes

Information for this article was provided by Mary Gardner, R.N., M.A., C.C.M., C.D.E., diabetes nurse educator program manager at the Johns Hopkins Diabetes Center.

Whether you inject insulin only once a day or multiple times, it is important to change the location of the injection in a methodical and consistent pattern that also takes into account the effect of physical activity on how quickly your body absorbs the insulin. This practice, known as injection site rotation, will prevent unsightly skin changes and unwanted variations in the rate at which the insulin gets into your blood stream.

Insulin is typically injected with a syringe or insulin pen into the layer of subcutaneous (beneath the skin) fat. Your blood vessels then absorb the insulin and ferry it to the rest of the body. Injections at the same spot too many times in a row can cause the fat to either lump up (lipohypertrophy) or waste away (lipoatrophy). These changes in the fat can impede absorption of insulin.

• Injection tip 1 -- Avoid areas with relatively higher concentrations of blood vessels and nerves that might get poked accidentally. Instead, give yourself injections in the abdomen (though not within two inches of your navel); the outsides of your upper arms, upper thighs, and hips; and the buttocks.
• Injection tip 2 -- Alternate injection sites within the preferred areas rather than between them. So, for example, if you have type 2 diabetes and take a single injection of long-acting insulin every day, you could inject on the left side of your abdomen for awhile, making sure to space injections at least an inch or so apart. Then, when you complete a circuit of the left side, switch your injections to the right. By the time you return to your starting position, the tissue on the left abdomen will have had time to rest and heal.
• Injection tip 3 -- Choose to use a different area for each insulin -- say, the abdomen for long-acting insulin, and the upper thighs for before-meal insulin shots. Again, switch sides for your injections to allow time for the tissue to recover.
• Injection tip 4 -- Be consistent. Due to variations in blood flow, the body absorbs insulin most rapidly in the belly area, followed by the arms, thighs, and hips or buttocks. Ideally you want your insulin to be absorbed at about the same rate each time you inject. This makes for more consistent and predictable control of blood sugar, avoiding dips and peaks. Otherwise, if you do notice an unexpected change in your blood sugar, how will you know what caused it? Was it exercise, a meal, or your medication?

Diabetes educators at the Johns Hopkins Diabetes Center encourage people to give injections in the abdomen as much as possible. It’s easily accessible and absorbs insulin the quickest. But if you take multiple insulins and would like to inject in a different area, they discourage the upper arms. The outer portions of the arms are harder to reach, and arm movements can affect absorption.

For more Alerts and Special Reports, please visit the Diabetes Topic page.

Johns Hopkins Health Alerts | Diabetes | How Injection Site Rotation Can Help You Control Your Diabetes