August 3, 2003
Blood Tests and Insulin Injections
Question from Herndon, Virginia, USA:
My eight year old daughter was diagnosed with type 1 diabetes three months ago. We just switched endocrinologists, and they seem to have different views on injection site rotation. The first doctor had my daughter on a two shot per day regimen of NPH with NovoLog had my daughter do her injections focusing on one body part at a time (using sites on that body part then moving to the next — thighs, stomach, arms). I think his goal was to maximize the time between injections in the same location. However, the new doctor has switched her to a three shot per day regimen with (NPH with NovoLog in the morning, NovoLog at dinner, and NPH before bed) and emphasizes keeping the injection in the same body part for each injection to get consistent absorption (i.e. evening and morning NPH in thighs, and dinner NovoLog in arms). Can you comment on these different approaches?
If forced to pick, I’d side with endocrinologist number two. There is evidence that absorption is fastest from the abdomen, then the arms then the thighs. This knowledge suggests that one of the many variables of insulin absorption can be minimised by sticking with a combination of injection time and body part. Provided that the actual site within the region is also varied, injection site lipohypertrophy can be avoided.