Ask an Expert FAQs — Your Insulin & Pumping Issues Questions Answered

1. I am sore from my injections. What are the best sites for injections? How often should I switch?
2. Are there side effects from using insulin?

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Q: I am sore from my injections. What are the best sites for injections? How often should I switch?

A: No medication changes should ever be made without a doctor's advice. There are several insulins, which are similar to each other, but made by different companies, which may be interchangeable, but, despite these similarities, still should not be changed unless prescribed by your doctor. That is because they all have slightly different chemical formulas, which can lead to different results when taken. Also, there are many different types of insulins and insulin mixes – 11 come quickly to my mind – therefore the possibility of interchanging the wrong types is a dangerous possibility. Occasionally a doctor will change your insulin and you will someday find bottles or pens of the old insulin in your refrigerator. These should not be substituted either. They were changed for a reason.

If, by your question, you meant do insulins sometimes need to be changed like oral medications do, the answer to that is yes. Diabetes, particularly type 2, is a progressive disease, which, as time goes by, may need different medications in order manage it effectively.

The most common injection site is the abdomen, followed by the legs, hips and arms. Basically, insulin can be injected anywhere you have adequate subcutaneous tissue (fat) to shoot it into. Because insulin is absorbed at different rates in these areas, (usually fastest in the abdomen), it is often suggested to rotate the area within one site, such as the abdomen, from side to side, always staying at least an inch away from a previous injection site, until that area is "used up", then moving on to the outer thighs, then the hips, and then the arms. Some people find one area more comfortable than another, but with practice and perhaps by trying different size and gauge needles, generally any area can work comfortably. You may want to visit with a Certified Diabetic Educator so she can see how you do your injecting and perhaps give you some pointers. Sometimes, icing the area for 30-60 seconds to numb the area gives enough relief to make injections more tolerable. Check this out for more information. - Anne Carroll, RN, CDE

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Q: Are there side effects from using insulin?

A: The two most common side effects from using insulin are hypoglycemia (low blood sugar) and weight gain.

Insulin made by the body, is a naturally occurring hormone that has various functions. One function is to help transport blood sugar inside the cells to provide them with energy, thus, lowering the level of sugar in the blood stream. So, you could imagine that too much insulin will lower the blood sugar levels below the desired range, causing hypoglycemia.

Injecting insulin creates additional hypoglycemia risk such as taking too much insulin or taking the wrong type of insulin at the wrong time (short-acting versus long-acting). Other frequent causes of hypoglycemia are missing meals, not eating enough food and excessive physical activity beyond the usual.

Having an understanding of the causes, signs, symptoms and ways to prevent hypoglycemia are very important when taking insulin. Be sure to talk with your health care provider about these things.

Weight gain can be a side effect to taking insulin simply because insulin enhances fat storage and prevents breakdown of fat for energy. Thus, it is very important to include exercise in your diabetes treatment plan and maintain a low fat diet. It is also essential to avoid taking "extra" insulin to have that tasty treat. It's a cycle many people fall into, but a better plan is to reduce your carbohydrate intake to allow for a treat now and then.

Aside from the above, there are a few other side effects of insulin to mention. First of all, allergies to insulin are rare, especially since most people in the United States are using either human insulin or purified pork insulin which is less antigenic than other animal insulin's. If an allergy does exist, it usually either occurs as local reaction, such as a skin rash or systemically, like anaphylaxis. Should you experience symptoms such as shallow breathing, wheezing, fast pulse, low blood pressure, perspiration, a rash over the entire body and/or shortness of breath upon first beginning on insulin, go to the emergency room immediately. These could be a sign of a severe allergic reaction.

Other side effects are limited to issues at the injection site. Atrophy or "pitting" of the fatty tissue occurs in few people. This is usually related to purity issues, so again, with the use of human or purified pork insulin's, less incidence has been observed. Hypertrophy is the thickening of fatty tissue under the skin. Lipodystrophy is scarring of the fatty tissue that appears like depressions in the skin. These both can be best reduced by rotating your injection sites and not re-using needles. To read further about proper injection technique and how to avoid skin problems, visit the website below.

Lastly, each type of insulin may have its own particular side effect. For example, one long-acting insulin manufacturer found during clinical trials that patients experienced mild pain at the injection site, more so than with other types of insulin. Be sure to read the package insert for your particular insulin prescription for possible side effects. You can also consult your doctor or pharmacist.

Below is an excellent web link for further information about insulin.

Insulin can be an excellent management tool for controlling blood sugars. Take the time to be well informed about the particular type of insulin you are being prescribed, be certain to always measure yourself the precise dose and follow your meal plan and physical activity routine regularly to ensure consistent results. - Missy Porteous, MS, RD, CDE

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Last Modified Date: June 17, 2013

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