I get lumps and bumps where I inject insulin. Is there something wrong?

The lumps you describe are fat deposits that may occur when insulin is injected into the same general area on a repeated basis.

These lumps can delay the absorption of insulin and cause unwanted glucose fluctuations that trigger low blood sugar, or hypoglycemia.

You should point these areas out to your doctor. In the meantime, you should avoid those areas for injecting to allow time for them to heal.

You should change injection sites to other areas.

Always keep 2 to 5 cm distance between old and new injection site. Something that could be helpful are “injection site templates”.

One easy way to remember to rotate injection sites is to inject on the right side (of the arm, leg, or belly) for any morning and lunch insulin, and on the left side (of the arm, leg, or belly) for the dinner and bedtime insulin.

Diabetes and exercise: When to monitor your blood sugar

Exercise is an important part of any diabetes treatment plan. To avoid potential problems, check your blood sugar before, during and after exercise.

Diabetes and exercise go hand in hand, at least when it comes to managing your diabetes. Exercise can help you improve your blood sugar control, as well as boost your overall fitness and reduce your risk of heart disease and nerve damage.

Diabetes and exercise pose unique challenges, too. Remember to track your blood sugar before, during and after exercise. Your records will reveal how your body responds to exercise — and help you prevent potentially dangerous blood sugar fluctuations.

Before exercise: Check your blood sugar before your workout

If you’re taking insulin or medications that can cause low blood sugar (hypoglycemia), test your blood sugar 30 minutes before exercising and again immediately before exercising. This will help you determine if your blood sugar level is stable, rising or falling and if it’s safe to exercise.

Consider these general guidelines relative to your blood sugar level — measured in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L).

Lower than 100 mg/dL (5.6 mmol/L): Your blood sugar may be too low to exercise safely. Eat a small carbohydrate-containing snack, such as fruit or crackers, before you begin your workout.

100 to 250 mg/dL (5.6 to 13.9 mmol/L): You’re good to go. For most people, this is a safe pre-exercise blood sugar range.

250 mg/dL (13.9 mmol/L) or higher: This is a caution zone. Before exercising, test your urine for ketones — substances made when your body breaks down fat for energy. Excess ketones indicate that your body doesn’t have enough insulin to control your blood sugar. If you exercise when you have a high level of ketones, you risk ketoacidosis — a serious complication of diabetes that needs immediate treatment. Instead, wait to exercise until your test kit indicates a low level of ketones in your urine.

300 mg/dL (16.7 mmol/L) or higher.: Your blood sugar may be too high to exercise safely, putting you at risk of ketoacidosis. Postpone your workout until your blood sugar drops to a safe pre-exercise range.

Since I have been taking insulin, I have the feeling that I am gaining weight. Is that possible?

Weight gain is a common side effect for people who take insulin — a hormone that regulates the absorption of sugar (glucose) by cells. However, controlling your weight is not only possible but also an important part of your overall diabetes management plan.

When you take insulin, glucose is able to enter your cells, and glucose levels in your blood drop. This is the desired therapeutic goal. However, if the number of calories you take in and your activity level result in more calories than you need to maintain a healthy weight, your cells will get more glucose than they need. Glucose that your cells don’t use accumulates as fat.

Weight gain may also be related to other complex functions of insulin in the body related to how cells use fats and proteins.

Eating healthy foods and staying physically active every day can help you prevent unwanted weight gain. The following tips can help you keep the pounds off:

Count calories. Eating and drinking fewer calories helps you prevent weight gain. Stock the refrigerator and pantry with fruits, vegetables and whole grains. Plan for every meal to have the right mix of starches, fruits and vegetables, proteins, and fats. Trim your portion sizes, skip second helpings and drink water instead of high-calorie drinks. Talk to your doctor, nurse or a dietitian about meal-planning strategies and resources.
Don’t skip meals. Don’t try to cut calories by skipping meals. When you skip a meal, your body is less efficient at using energy, and you’re more likely to make poor diet choices at the next mealtime because you’re too hungry. Skipping meals also causes large fluctuations in blood sugar levels. Three modest meals a day with healthy snacks in between can result in better control of weight and blood glucose levels.
Be physically active. Physical activity burns calories. A reasonable goal for most adults is a minimum of 150 minutes per week of moderately intense aerobic activity — such as walking, bicycling, water aerobics, dancing or gardening — plus muscle-strengthening exercises at least two times per week. Talk with your doctor about activities and exercises that are appropriate for you.
Ask your doctor about other diabetes medications. Some diabetes medications that help regulate blood glucose levels — including metformin (Fortamet, Glucophage, others), exenatide (Byetta), liraglutide (Victoza) and pramlintide (Symlin) — may promote weight loss and enable you to reduce your insulin dosage. Ask your doctor if these or other medications would be an appropriate part of your diabetes treatment plan.
Take your insulin only as directed. Don’t skip or reduce your insulin dosages to ward off weight gain. Although you might shed pounds if you take less insulin than prescribed, the risks are serious. Without enough insulin, your blood sugar level will rise — and so will your risk of diabetes complications.

Insulin Safety

For many people with diabetes, injecting two types of insulin is a daily requirement. Giving yourself your injections can become so much a part of your routine that you can do it without thinking — which can lead to errors.

To increase insulin safety and avoid taking the wrong insulin:

Pause and double-check that you’re taking the correct insulin.
Label insulin vials or pens with different-colored tape, so that you can differentiate between them. For example, use red tape for short-acting insulin and yellow tape for long-acting insulin.

If you accidentally give yourself the wrong insulin:

Call your local emergency number.
Test your blood sugar frequently until help arrives. Eat or drink a fast-acting carbohydrate to maintain a blood sugar within your goal range.

In preparation for such issues, it’s a good idea to always carry a simple sugar source with you, such as glucose tablets, juice, regular soda or hard candy.

Injecting Insulin

How to inject insulin?

The concentration (strength) of insulin is measured in USP Insulin Units and USP Insulin Human Units and is usually expressed in terms such as U-100 insulin.

It is important to follow any instructions from your doctor about the careful selection and rotation of injection sites on your body.

To prepare your insulin injection correctly:

Wash your hands with soap and water.
Before every injection you should shoot 1 to 2 units into the air until you see a drop on the tip of the needle. This way you make sure that the pen is functioning. In case there is no insulin coming out of the pen, it might be that the cartridge is empty, the needle is clogged or that the piston position is not correct.
If you are using intermediate insulin, mix the insulin by rolling the pen slowly between your hands at least 20 times. Never shake the pen vigorously (hard).
Do not use the insulin if it looks lumpy or grainy, seems unusually thick or seems to be even a little discolored.

Do not use the insulin if it contains crystals.

Regular insulin (short-acting) should be used only if it is clear and colorless

Adjust the right dose of insulin with the dosage knob
Chose the optimal injection site: abdomen, outer thighs or buttocks.

At the abdomen the insulin ill be absorbed the fastest. The area around the navel (around 8 cm surrounding the navel) should not be used. Insulin that is injected into the thigh or the buttocks will be absorbed slower. Talk to your doctor to see which injection site to use.

Avoid areas with scarring (old surgery sites) or moles because the tough tissue may not absorb insulin well
Gently pinch your skin with your free hand to avoid any damage of the vessels or muscles.
Do not inject insulin through clothes.
Always inject the length of the needle either straight or slightly diagonal into fatty tissue.
Do not pull the needle instantly out. Leave it at least 10 seconds in to make sure that the insulin is distributed.
After each injection change the injection site.
Use the needle of the pen only once. If you use the needle too often it can cause tissue changes which will prevent the absorption of insulin.

Leaving an insulin needle attached to an insulin pen can lead to unintentional air entering into the insulin pen. If unintentional air enters into the insulin pen, it can contribute to air bubbles accumulating within the insulin and pen and ultimately improper dosing of insulin. It could also lead to insulin contamination.

To make sure that insulin is correctly distributed

Use the right needles depending on your fatty tissue. For the optimal injection the length of the needle is important. Needles are available for children, skinny, and normal as well as more corpulent people with diabetes.
Always use the same body region at the same time of the day (e.g. morning the abdomen, evening the thigh) otherwise there may occur variations in the blood sugar levels

Changes in dose—your doctor may change the first dose of the day. A change in the first dose of the day might change your blood sugar later in the day or change the amount of insulin you should use in other doses later that day. That is why your doctor should know any time your dose changes, even temporarily, unless you have been told otherwise.

On sick days—when you become sick with a cold, fever, or the flu, you need to take your usual insulin dose, even if you feel too ill to eat. This is especially true if you have nausea, vomiting, or diarrhea. Infection usually increases your need for insulin. Call your doctor for specific instructions. Continue taking your insulin and try to stay on your regular meal plan. However, if you have trouble eating solid food, drink fruit juices, non-diet soft drinks, or clear soups, or eat small amounts of bland foods. A dietitian or your doctor can give you a list of foods and the amounts to use for sick days. Test your blood sugar level at least every 4 hours while you are awake and check your urine for ketones. If ketones are present, call your doctor at once. If you have severe or prolonged vomiting, check with your doctor. Even when you start feeling better, let your doctor know how you are doing.

Storage

Store in the refrigerator. Do not freeze.

Store your insulin in the refrigerator, in an insulated case or cooler with a freezable gel pack, or use a cooling wallet. Cooling wallets are available through many diabetes supply companies and keep insulin vials, pens and pumps cool at a safe temperature without the need for refrigeration or ice. The wallets have a liner filled with crystals. The liner is immersed in cold water for 10-15 minutes, and placed back into the wallet, along with the insulin. It works by relying on the process of evaporation for cooling, can keep insulin cool for up to 48 hours, and is reusable

Unopened bottles of insulin should be refrigerated until needed and may be used until the printed expiration date on the label. Insulin should never be frozen. Remove the insulin from the refrigerator and allow it to reach room temperature before injecting it.

An insulin bottle in use may be kept at room temperature for up to 1 month. Insulin that has been kept at room temperature for longer than a month should be thrown away.

Storing pre-filled syringes in the refrigerator with the needle pointed up reduces problems that can occur, such as crystals forming in the needle and blocking it up.

Never freeze insulin or expose it to extremely hot temperatures or direct sunlight. Never leave it in your car. Never place it directly on ice or an ice pack.

Throw away insulin that is discolored or contains solid particles.

Remember, after opening a vial of insulin or starting a new insulin pen, the insulin loses its potency and should be thrown away after a certain number of days, depending on the manufacturer’s guidelines. Generally, most vials of insulin are good for 28 days after opening with the exception of Levemir (detemir), which is good for 42 days. Other pens are good for 10, 14, 28 or 42 days. Check the medication insert.

What about insulin pumps?

Heat can make proteins like insulin harden, which increases the potential for infusion set occlusions (blockage). If you live in a hot climate and especially if you work outdoors, you may need to pay closer attention to how the heat can affect your insulin. Using a pump wallet could be another option for people concerned about the effects of heat on their insulin. Also, make sure that the infusion set tubing is tucked in your clothing and not hanging out and exposed to the light and or heat.