Beginner’s guide to insulin injections

If you have a needle phobia, you don’t want to get type 1 diabetes. A lifetime of insulin injections is daunting to anyone. Now imagine you’re so scared of needles that a simple blood test makes you pass out. When there’s a gory injection scene in a movie you have to look away not to feel ill. That used to be me.

When I ended up in hospital with diabetic ketoacidosis one thing was clear. I needed insulin to live. I had no idea how to get it into myself though. How on earth would I be able to take four injections a day? Not to talk about the blood tests that went with it. A diabetic nurse helped me get started, and a couple of days later they sent me home with insulin pens. I was “injection-trained” and on my own.

The experience was terrifying. Many meals went cold while I sat at the kitchen table with the insulin in my hand, unable to inject it. Good thing I like salads. Some days were easier than others, but that first week was tough. Then things got better. The needle phobia disappeared. A few weeks in, I realized it didn’t bother me the slightest anymore.

People think the worst thing about having diabetes is the injections. It’s not. Injecting insulin becomes second nature. In the same way you tie your shoelaces or brush your teeth in the morning, you take your insulin.

Here are some tips on injections and the common problems you might run into. I hope they’ll help you out.

How to inject

The needle is very short (4-6mm), so you can stick it in at a 90 degree angle, or pinch a fold of the skin and inject at 45 degrees. Either works. When I was getting used to injections I found the latter way far easier.

Your injection technique should be the same as when you throw a dart, fast. If you hesitate and go slow it will hurt. Practicing on fruit like tomatoes is helpful if you’re struggling with needles. You’ll find many injection aids for hiding needles. If you’re looking at a lifetime of injections, I think you’re better off getting used to them.

There’s no need to use alcohol wipes, providing your skin is clean.

You can inject through clothing. It took me a few months to get comfortable with this, and I still only do it if I’m in a public place.

It’s good practice to change needles after every injection, though many diabetics don’t.

Reusing needles you risk bacterial growth and fragments from the needle tip breaking off (you need to use it more than seven times for this to be an issue). I change mine every evening on my three pens, using one needle 2-4 times.

Studies also links needle reuse to lipohypertrophy, or fat lumps. Insulin is a fat-building hormone, so it makes sense that the volume you inject is important. I never take more than 6u in a single shot.

Prime your needles by squirting 1-2u of insulin into the air. This makes sure they’re not blocked and it’s especially important if you’re reusing needles.

Where to inject

The common injection sites are the places where you have fat – the belly, thighs, arms and buttocks. I inject bolus (fast-acting) into my belly and basal (long-acting) into my buttocks. Insulin absorbs the fastest in the belly region, which makes it a good place to dose for your meals.

You should rotate injection sites to avoid lipohypertrophy. Rotating sites doesn’t mean you have to move from belly to thigh, but space your injections by an inch. I use abdominal quadrants. My endocrinologist told me to avoid the thigh, as there’s often not enough fat in this area. The diabetic nurse who taught me to inject told me the opposite. It just goes to show that if you ask a hundred people what they think of something you’ll get a hundred different answers. This happens a lot with diabetes.

When to inject

Many diabetics pre-bolus and split-bolus. When you pre-bolus you take insulin 15-40 minutes before a meal to give the insulin time to enter the blood. It makes you less likely to spike from the carbohydrates, but the timing can be tricky. You have to be careful to avoid hypoglycemia.

With split-bolus you give several injections for the same meal. The reason is either that there’s a lot of fat in the food, causing the carbs to get released slower, or that you’re dosing for protein. This reduces the risk for hypoglycemia and gives you better blood glucose control. It does take a bit more time and effort though.

When I was first diagnosed I felt overwhelmed by the insulin dosing. I let the bolus calculator in the Diabetes M app figure it out for me. Give it a shot if you’re struggling.

Common issues you might run into

Bleeding: Sometimes there will be a bit of blood when you pull out the needle. You’ve hit a small vessel and it’s nothing to worry about. I’ve done it plenty of times, and it’s never had any effect on insulin absorption.

Skin bubbles: The skin bulges out after injecting in what looks like a mosquito bite. It happens because the needle doesn’t go deep enough, so the insulin gathers in a pool close to the skin surface. I’ve done this a few times, and the bulge disappeared within 15 minutes. The insulin has worked without any problems.

Bruising: I used to bruise all the time when I was injecting larger insulin doses. Especially the basal dose (11u), which I took in one hit. Now I split it over two injections (6+5u) and it’s rare that I bruise. It’s possible I got better at giving injections, but I think it’s more that it’s difficult to inject a larger volume and you end up pushing harder. Using the NovoPen rather than the disposable plastic pens makes injecting smoother. Like the difference between writing with a Bic or a Mont Blanc.

Bubbles in the pen: I used to waste time and insulin trying to get rid of these bubbles. Now I leave them, the bubble flows to the bottom when you turn the pen at an angle to inject so it’s not an issue. If it bothers you the trick is to hold the pen with the needle tip pointing up and tap it to get the bubble to the top. Then shoot out a large amount of insulin, more than 5u is often needed.

Insulin drops when pulling needle out: If you pull the needle out too fast after injecting you might lose some of the dose. Hold the needle in for longer and pull out slower, pausing for a couple of seconds halfway. Whereas you should be fast when injecting to avoid pain, the same thing doesn’t apply on the way out. If you’re injecting a larger dose and you lose a tiny drop it’s not important. It only matters when you’re injecting very small doses like 1/2u of insulin. Pulling the needle out too fast you can end up losing you the entire dose. If this happens to me I never re-inject. With insulin it’s always better to miss a dose than to overdose.