Gao Hongjiao, Department of Endocrinology, Zunyi First People’s Hospital
The parts of the body suitable for subcutaneous insulin injection are the abdomen, outer thighs, outer arms and buttocks, which are shown in different colors in the figure below, mainly because there is a layer of subcutaneous adipose tissue underneath these parts that can absorb insulin and there is no more nerve distribution.
1. Abdomen: Cover the belly button with one of the patient’s fists (do not inject insulin below the fist, within 5 cm of the umbilicus) and inject within a distance of about one palm on both sides of the belly button. When injecting in the abdomen other than this, the needle will easily stick to the muscles, and even for those who are overweight, the subcutaneous layer becomes thinner as it moves to the sides of the body. 2.
2. Arms: The outer quarter of the upper arm should be selected for injection (the outer part of the lower deltoid muscle of the arm).
3. Thighs: The front or outside of the thighs should be chosen for injection to avoid the insulin needle stabbing the blood vessels and nerves (because the blood vessels and nerves of the thighs are mostly distributed on the inner side).
4. buttocks: the injection site is at least 10 cm far down from the upper edge of the hip bone (the buttocks are usually at the upper outer part).
The absorption rate of insulin varies from one injection site to another, and the choice of injection site depends on the patient’s condition and the type of insulin used.
The ideal injection site for short-acting insulin: the abdomen.
Fast-acting insulin analogues can be injected anywhere.
The ideal injection site for medium- and long-acting insulins (e.g., medium-acting insulin injected at bedtime) or long-acting insulin analogs: thighs, buttocks.
Premixed human insulin or premixed insulin similar to physical think injection site: (morning) abdomen, (evening) thighs or buttocks.
For the above reasons, in order to better predict the effect of each insulin injection, it is necessary to keep the same injection site at the same time every day, so please do not confuse the injection site and time. For example, if the insulin injection site recommended by your healthcare provider is in your abdomen every morning, you should not inject in your legs or other areas. You should always choose to inject in the abdomen in the morning.
The disadvantages of multiple injections at the same injection site include: formation of subcutaneous hard nodes and fat atrophy; affecting insulin absorption, which is not conducive to blood sugar control; affecting the appearance of one’s image, causing fear and resistance to injections, and reducing compliance with insulin therapy. Therefore, injection sites should be rotated to avoid the above problems.
Rotating between the four areas of abdomen, upper arm, outer thigh and buttocks is called “grand rotation”. Smaller rotations within each area are called “small rotations”. Each injection site should be more than 25cm apart, and try to avoid using one injection site repeatedly within a month.
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