Where should I inject insulin using a pen?

  • Always inject insulin subcutaneously (in the fatty tissue that lies over the muscle). Recommended injection sites depend on the type of insulin prescribed to you. Please consult with your diabetes team and follow the prescription information of your insulin.
  • If you inject too frequently in the same site, hard lumps or knots develop and the insulin action may be delayed or erratic, potentially worsening diabetes management. Practice proper site rotation to avoid these problems.

How can I inject insulin correctly using a pen?

  • In most cases, it is not necessary to lift a skin fold when using a 4 mm needle. Insert the needle "straight in", at a 90 degree angle, inject the insulin and hold the needle in the skin while slowly counting up to 10. However, to prevent possible intramuscular injections when injecting insulin into a limb or a thin abdomen, even a 4 mm needle may warrant the use of a skin fold.
  • When injecting insulin with a 6 mm needle, you should either lift a skin fold or insert the needle at a 45 degree angle.
  • When using an 8 mm pen needle or longer, you should lift a skin fold and inject the insulin at a 45 degree angle in order to avoid intramuscular injections.
  • To make a proper skin fold, use your thumb and index finger (possibly with the addition of the middle finger). If you use all of your fingers, you will risk lifting muscle along with the SC tissue, which can lead to IM injections. The lifted skin fold should not be squeezed so tightly that it causes blanching or pain. Please discuss with your diabetes team if and when you should use a skin fold and practice the proper technique.

How can I determine the appropriate needle length?

The decision as to which needle length to use is an individual one, made jointly between you and your diabetes team. It is based on multiple factors, including the amount of subcutaneous tissue at the recommended injection sites, the injection technique, the insulin type and your personal preference. Longer needles may increase the risk of intramuscular injection. Shorter needles are usually considered to be safer and are often better tolerated.

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