QA and BI preferred injection sites

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Garry DAFNE Graduate
North Lincolnshire
328 posts

Following a General thread:
I follow the same rules as marke.
I was advised QA - stomach and arms - for quick uptake.
BI in legs - for slower absorbtion. That is what I have followed after being given this info during my DAFNE course in November 2009.
I wonder whether Carolin would express an opinion and be good enough to comment?

novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

I would also like to hear views of the professionals...........

I cant recall being given this advice during my time as a diabetic, however that doesn't mean I wasn't told, only that I cant remember............. Wink

My understanding though is that the new insulins' we take like novorapid and levemir etc... are engineered to last a certain length of time, so we shouldn't need to use more/less absorbent areas of our bodies to assist the insulin.....

should we?

susanh DAFNE Management
Diabetes Australia-Vic, Melbourne, Victoria
20 posts

Hi guys,
Catherine, one of our diabetes educators down under has written up a detailed response for you - hope it helps!

Studies show that insulin injected into the abdominal fatty tissue has the fastest and most consistent rate of absorption. The arms and thighs have a slower absorption rate, and the buttocks appear to have the slowest. Evidence shows that rapid acting analogues eg. NovoRapid, Humalog and Apidra can be given at any of the sites mentioned above without too much difference in absorption rates. The same goes with long acting analogues eg. Levemir or Lantus, but be careful not to inject into the muscle for risk of hypo. If you’re using human insulin such as Actrapid the abdomen is preferred due to faster absorption and if using NPH the thigh and buttocks are preferred due to the slower absorption.

Traditionally, the abdomen (avoiding the belly button area), thighs and buttocks have been the preferred site for injections. The arms have been least preferred in the adult population due to the increased risk of injecting into the muscle. Having said that, movement of a muscle speeds up the absorption rate of insulin even when injected into the fatty tissue and therefore you may increase your risk of hypos if you inject into thighs or arms before exercise.

BI (long acting analogue) needs to be injected in a different area from QA so that they do not mix and inadvertently change the profile of either insulin.

Some health professionals advise injecting BI into the same area of the body (whilst rotating sites within that area) mainly so that there is a consistency of absorption from one day to another. This makes sense if we’re saying that different areas of the body have different rates of absorption.

Remember to rotate and inject about 2 cm away from the previous injection so as to avoid causing scar tissue to develop. Also, if using the buttock for instance, make sure to use both buttocks evenly and not prefer one over another simply because it is easier to reach. Keep in mind that needle length, the angle at which the needles are injected and whether the skin requires a pinch up need to be considered to avoid injecting into muscle.

It’s important that individuals have their injection sites reviewed by their HCP to assess for lipohypertrophy or scarring. Avoiding scarred areas if present is essential as injecting into these may cause erratic insulin absorption hence erratic BGs.
If you’re confused or overwhelmed with the different information and advice that you get remember that everyone is different and people have individual responses in regards to absorption rate of insulin at different sites. If your BGs are not stable consider recording the site of your injection in your diary to see whether it makes a difference to your BGs and then discuss this with your HCP.

Susan & Catherine

novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

Thanks for that...............

I would like to see if there is any evidence to suggest keeping BI in the same area is in fact more consistent/manageable.........purely as for me personally my injecting BI anywhere is working.......... Very Happy