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Medical Forum / Diseases and Disorders / Diabetes / January 2009

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Do injection sites matter?

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JC - 30 Jan 2009 07:54 GMT
Hi,

I am injecting insulin, Novorapid before meals and Lantus last
thing before bed, using various spots on the stomach.   I have
noticed that at different times the effect of the injection seems
to vary - the amount injected is the same, the food is similar
but the site selected may vary.

Due to previous cancer operations I only use the left hand side
of the stomach area as the right hand side is full of operation
scar lines and thus, is to be avoided.

In some cases it is as if I hadn't done the injection at all.

That has led me to wonder if the injection site can have an
effect on the insulin.  I am aware that we are not a perfect
machine and that we don't always react the same to the same
stimulus so this may be the cause.

I have also noticed that certain areas bleed indicating that I
have hit a blood vessel.   Short of putting a marker on the skin
I don't see how to avoid this happening occasionally.

I would appreciate any feedback that you can give me on these
topics if possible.
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Cheers . . . JC

DLynch - 30 Jan 2009 16:49 GMT
> Hi,
>
[quoted text clipped - 21 lines]
> I would appreciate any feedback that you can give me on these
> topics if possible.

One thing comes to mind.  Never inject novorapid and lantus into the same
area.  Just like you should never mix these two insulins.  Try using the
upper quadrant for one type, and the lower quadrant for the other.
JC - 30 Jan 2009 22:12 GMT
> > Hi,
> >
[quoted text clipped - 3 lines]
> > to vary - the amount injected is the same, the food is similar
> > but the site selected may vary.

Snip

> > I would appreciate any feedback that you can give me on these
> > topics if possible.
>
> One thing comes to mind.  Never inject novorapid and lantus into the same
> area.  Just like you should never mix these two insulins.  Try using the
> upper quadrant for one type, and the lower quadrant for the other.

OK, I will do that from now on.  

Why is this so?   The two insulins must mix after the injection
as the Lantus lasts for 24+ hours.   Wouldn't that mean that both
are present in the blood stream?
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Cheers . . . JC

DLynch - 31 Jan 2009 16:13 GMT
>> > Hi,
>> >
[quoted text clipped - 18 lines]
> as the Lantus lasts for 24+ hours.   Wouldn't that mean that both
> are present in the blood stream?

From the lantus website, under precautions:

LANTUS must NOT be diluted or mixed with any other insulin or solution. If
LANTUS is diluted or mixed, the solution may become cloudy, and the
pharmacokinetic/pharmacodynamic profile (e.g., onset of action, time to peak
effect) of LANTUS and/or the mixed insulin may be altered in an
unpredictable manner. When LANTUS and regular human insulin were mixed
immediately before injection in dogs, a delayed onset of action and time to
maximum effect for regular human insulin was observed. The total
bioavailability of the mixture was also slightly decreased compared to
separate injections of LANTUS and regular human insulin. The relevance of
these observations in dogs to humans is not known.

I think it has to do with the PH of lantus.
Herman Rubin - 31 Jan 2009 19:54 GMT
>> > Hi,

            .......................

>> One thing comes to mind.  Never inject novorapid and lantus into the same
>> area.  Just like you should never mix these two insulins.  Try using the
>> upper quadrant for one type, and the lower quadrant for the other.

>OK, I will do that from now on.  

>Why is this so?   The two insulins must mix after the injection
>as the Lantus lasts for 24+ hours.   Wouldn't that mean that both
>are present in the blood stream?

Insulin is injected into fatty tissue and seeps from there
into the blood stream, where it does not last long.  The
various types of insulin are designed to seep at different
rates, and contact can upset the rate.

Compare the timing of insulin shots with the 9 minute average
length of time of insulin in the blood stream, and you sill see
that this is necessary.
Signature

This address is for information only.  I do not claim that these views
are those of the Statistics Department or of Purdue University.
Herman Rubin, Department of Statistics, Purdue University
hrubin@stat.purdue.edu         Phone: (765)494-6054   FAX: (765)494-0558

 
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