My 10 year old son has had type 1 diabetes since he was 18 months old and just recently started giving his own shots — we are very proud! He is very thin and gives his shot in the arm and thighs. He has noticed when he bends his arm it feels tight or stiff in the area were it has been built up with insulin. What can we do to help with the build up or the stiffness?

Congratulations on your son’s success at administration! This is a typical time when children want (and need) some degree of independence. But a word of caution: sometimes, if given too much latitude, when these youngsters are teens, they’ve grown accustomed to “self-reliance” and often get “too proud” to ask for parental help and glucose readings can go haywire with puberty. So encourage this positive step but be certain to let him know that you want to continue to supervise and be there for him.

As for the tightness and stiffness, I can’t tell from your description, but this sounds a bit like lipoatrophy, which usually causes “lumps and bumps” at injection sites used too often. Essentially, a kind of “scar” forms within the fat tissue under the skin. Kids prefer to use those same sites as it often is associated with less discomfort, but insulin absorption can be less smooth. An easy approach would be to try to rotate the injection sites to include the arms, legs, abdomen, and hips. You can still use the arms, but try to avoid the “tight” spots. Even thin children tend to have enough tissue under the skin to pinch up a bit for an injection. Sometimes, young persons are fearful of the abdominal injections, but usually, those spots hurt less than the arms or thighs. A great spot is an area along the back of hip, near the butt. Your son’s diabetes nurse can review “shot-spots” with him and you.

DS