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| Volume 3 |
February 2006 |
Number 1 |
An Exclusive Continuing Education Publication of Acadiana Consultant Pharmacy Service
Author, Publisher, Editor-in Chief, Typesetter & Printer, Charles S. Feucht,PD,FASCP PharmD candidate
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Medication News & Update
Insulin Injections
 There are many factors that can cause variations in blood glucose levels but the one we want to address here is insulin absorption differences between injection sites. The fastest absorption typically takes place from abdominal sites especially just above the umbilicus. Absorption of insulin from the arm is somewhat slower and when insulin is injected in the thigh and buttocks these are the slowest rates of absorption. The only insulin which does not vary in absorption between sites is insulin glargine (Lantus).
Patients have been taught to vary their injection sites throughout the body, and some nurses have mistakenly administered insulins in this manner. This results in the insulin peaking earlier one morning and then wearing off, and on another day the insulin peaks later resulting in an extended effect. In the elderly patent this can be extremely troubling and also for brittle diabetics. Actually the proper method is to follow this rule: Insulin injections should be given in the same region at a specific time of day and rotated within that region. In general, it is recommended that patients think of each injection site as being a quarter-sized zone. Patients should rotate sites to minimize the chance that they inject into the same quarter-sized zone more often than once a week. The longer the interval between injections at the same site, the less likely it is that there will be chronic tissue injury. The interval should be longer in pump wearers. We recommend giving twice daily background insulin( NPH, Lente, Ultralente) injections in the leg. For monotherpay or mealtime injections with Regular, lispro, or aspart insulins we recommend the abdomen. These last three insulins could also be given in the arm but then rotation should be from arm to arm sites not abdomen to arm or vice versa.
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