The most common injection site is
1)The abdomen (or stomach)
2)The back of the upper arms.
3)The upper buttocks or hips.
4)The outer side of the thighs.
Rotating Your Injection Sites
If you inject insulin three or more times
a day then it’s a good idea to rotate your injection sites. Injecting in the
same place much of the time can cause hard lumps or extra fat deposits to
develop. These lumps are not only unsightly; they can also change the way
insulin is absorbed, making it more difficult to keep your blood glucose on
Follow these two rules for proper
- Same general location at the
same time each day.
- Rotate within each injection
site rotation is important for both insulin syringe and pen users.
Same Time, Same General Location
Insulin is absorbed at different speeds depending on where you inject, so it's
best to consistently use the same part of the body for each of your daily
Fastest from the abdomen (stomach)
- A little slower from the arms
- Even slower from the legs
- Slowest from the buttocks
1) It is a good idea to inject your
breakfast and lunch bolus doses into the abdomen.
2) Your supper or bedtime dose of
long-acting insulin could be injected into the thigh, buttocks, or upper arm.
3) If you mix two types of insulin
in one shot, you can inject into the abdomen, arm, thigh, or buttocks.
4) Rotate Within an Injection Site
5) To avoid developing hard lumps
and fat deposits, it is important to inject in different spots within a general
part of the body.
Inject at least one finger’s width from the last injection.
Smart Tips for Site Rotation
- Do not inject close to the
- For the same reason, do not
inject close to moles or scars
- If you inject in the upper arm,
use only the outer back area (where the most fat is).
- Move to a new injection site
every week or two.
- Rotate the sides (right, left)
of your body where you inject within your injection sites.
Suitable injection sites
Insulin is not absorbed at the same speed at all sites
- Abdomen and thighs are the most common injection sites.
- Injection sites on the abdomen allow rapid insulin absorption.
- Injection sites on the thighs and buttocks allow slow insulin
- The effect of analog insulins is less dependent on the
- muscle as the subcutaneous fatty tissue is very thin and the
injection sites are not easily accessible.
Rotation principle for injection sites – Avoiding
lipohypertrophy (tissue hardening)
- Change the injection site after every injection (rotation
- The injection sites should be at least 3 cm away from the navel
and apart from each other to avoid frequent injections into so-called
“favourite sites” and thus leading to tissue hardening (lipohypertrophy).
The correct injection technique
The insulin is injected into the subcutaneous fatty tissue
Subcutaneous fatty tissue
To achieve a good insulin dose effect it is essential to
inject the insulin into the subcutaneous fatty tissue (subcutaneous injection)
and not into the muscle. If insulin is injected into the muscle, this can lead
to severe hypoglycaemia.
Inject insulin into the
subcutaneous fatty tissue
inject insulin into muscle
The correct needle length and injection technique is crucial
for correct injection
- Injections with ultra short pen needles (4 and 6?mm) provide
reliable insulin delivery into the subcutaneous fatty tissue (subcutaneous
- The correct needle length is crucial and is determined in
consultation with your physician at the start of pen therapy.
- The choice of injection technique together with the right
needle length can avoid injection into the muscle.
As a rule, the following needle lengths are
- Children and adolescents
4 or 6 mm needle length
4, 6 or 8 mm needle length
In general, therapy tends to be started with the shorter pen needles.
The correct injection technique for different needle
For 4 mm needle length
Hold the needle vertically at an angle of 90 degrees, without creating skin
fold (for some children, very slim adults and when injecting into the thigh,
forming of a skin fold may prove necessary).
For 6 mm and 8 mm needle length
Injection at an angle of 90 degrees with a skin fold or 45 degrees without a
Correct forming of a skin fold
- Create the skin fold using thumb and index finger (possibly
also using middle finger).
- Keep skin fold loose and relaxed. Do not press together hard,
resulting in pain or turning the skin white.
- If all fingers are used, there is a risk of also including the
muscle. This can lead to an undesired intramuscular injection.
Single use pen needles
Risks of multiple use
Multiple use of the pen needle can lead to the
- The needle is already somewhat blunted after single use, the
lubricant film can show signs of wear and the tip of the needle can be
- Injections become more painful.
- This can lead to small injuries or bruising.
- The pen needle is no longer sterile after initial use:
- Re-use is not hygienic.
- Increased risk of infections.
- Insulin can crystallise in the pen needle:
- The pen needle may become clogged and a safe insulin injection is
therefore no longer
- This can lead to dosage errors and unexpectedly high blood glucose
- Presence or increase in size of air bubbles in the cartridge:
- Insulin may drip out of pen needle (during storage).
- Insulin dose becomes inaccurate.
Storing insulin -
• Spare insulin should
be kept in the fridge at between 4 C and 8 C , Pen in use should be maintained
• Cold insulin may take
longer to absorb and cause stinging. Give the insulin at least half-an-hour at
room temperature before injecting
• Insulin can be stored
in earthen pot (on sand) in cold and dry place away from sun light even in a
• The insulin device or
cartridge in use can be kept at normal room temperature for one month
• Keep insulin away
• Always check the