A Good Tip For Giving Yourself Insulin Shots

[Blaine]

Lightly, not even enough to break the skin, search for a spot where you don't feel the needle. That's the spot. Other than that, you have a real good chance of hitting a nerve that feels like a hornet got ya.

[rossim92]

Ouchhhhhhhhhhhhhhhhh!!!!!!!!! I hate needles. spent time in hospital as a baby. I tolerate needles better now then I used too. Since I'm gettting older, doctor visits becoming common,

[AJMD429]

We use daily subcutaneous shots for testosterone instead of weekly imtramuscular ones; they hurt so much less that patients can self-administer easily.

[jeepnik]

Ahh, now we get to an area of my expertise.

First use the prefilled injectors. I use one called Humulin. The needles that work with it are short and very fine. Unless you do hit a nerve, and you can't always avoid that, their isn't any pain.

When preparing the skin for the injection use those little prewetted alcohol swabs. Clean the area well, and here's the tip, let the alcohol dry for a few seconds. I think most of what you end up feeling is the sting of the alcohol when you break the skin.

I find the abdomen to be a good place. Not that many nerve endings compared to other places. And in my case, there's a fair amount of real estate. Try to avoid using the same general area repeatedly. The front of the thighs seems to work well also.

Also, don't be tentative. Stick it in, inject, wait a couple of seconds and pull it out. (I just realized how that sounds. Get your minds out of the gutter).

I really hate to say this, but U-tube has a lot of videos. And after about a week you'll be an old pro.

[Bill in Oregon]

Blaine, does this mean you are on insulin now? Take care!
I wonder about using the lower back. There seem to be fewer nerve endings in this thicker skin area.
Hope I don't have to go down this road, but my recent blood glucose was 104, not good.

[AJMD429]

When preparing the skin for the injection use those little prewetted alcohol swabs. Clean the area well, and here's te tip, let the alcohol dry for a few seconds. I think most of what you end up feeling is the sting of the alcohol when you break the skin.

This reminds me of the issue when treating FEMALE menopause....

....we often use testosterone gel to facilitate libido, and the traditional products were for men, so not only had a much higher dose (females with decent libido have testosterone level around 40 versus males around 800), but the creams (oral sex hormones are NOT generally safe or effective) were alcohol-based for men, who generally applied them under the armpits or on the thighs or torso, versus women who apply them to the WAY more sensitive areas of the minor labor or clitoris, so women MUST do something to let the alcohol evaporate....!

Thankfully, now there are products developed specifically for women, that are not alcohol based, and they can use them in the appropriate areas....!

Males - we have a gradual, and very variable 'menopause', that results in our 'sex' hormones* starting to drop in our 30's and gradually dropping after that. WOMEN tend to have a decent 'sex' hormone level up until their 40's, and indeed don't quit menstruating until they are over 50 year of age normally.

So.....for WOMEN, we ignore all the issues (difficulty relaxing in the evening, sore breasts, 'dense' breasts on mammograms, fatigue and weight gain, and decreased libido) until they actually cease menses. That is an AWFUL way to neglect their mental and physical health....

For MEN, all we focus on is the bedroom function, and if that is 'ok' (perhaps because their wife has no libido), we just wait until they have a heart attack, THEN we start paying attention to their hormone levels (....testotstroene is NOT just a 'sex' hormone, no more than estrogen is for women - both hormones have HUGE effects on the cardiovascular system, bones, mental clarity, energy, and so on...).

It is "NATURAL" for both sexes to DIE in their 30's or 40's - but today we kind of like surviving to great-grandparent-hood, and given the nature of 'humans' needing lots of nurturing and education aside from just the basic 'biological survival mode', we all need to attend to the idea of having good mental and physical health after age 50 or so (the long-term historical extreme lifespan).

If your physician isn't really into such things.............GET A NEW PHYSICIAN....

[Bill in Oregon]

Doc, your comments are always such a welcome blessing here. Thanks.

[piller]

There are different rates of absorption when insulin is injected into the skin of the stomach versus the skin of the thighs or upper arms. The insulin is best injected into the fat layer under the skin. The 32 gauge 4mm long screw on needles for the pens are as close to unnoticeable as we currently can get. The 31 gauge short needles on syringes for use with insulin bottles are the thinnest for that purpose at the moment. BD or Novo Nordisk are usually the sharpest, smoothest, and highest quality. Store brands are not too bad, but Becton Dickson and Novo Nordisk are the best. Less pain because needles are sharper, smoother, more consistent, and of better quality steel in the needle so it is less likely to bend.

[piller]

Ever since I had a bad reaction to Ciprofloxacin in August and my blood sugar went to 820 and I went into a temporary coma, I have been on insulin. No, it is not fun. It is also a P.I.T.A. when your District Manager keeps having your schedule changed so that you cannot plan for meals or snacks. The DOJ has been notified and is investigating these ADA violations.

[Blaine]

Blaine, does this mean you are on insulin now? Take care!
I wonder about using the lower back. There seem to be fewer nerve endings in this thicker skin area.
Hope I don't have to go down this road, but my recent blood glucose was 104, not good.

For quite a while...13 years or so?
It's well managed...the last couple A1Cs were 6.1 without taking the Metformin (that gives me the runs)

At any rate, I'm stuck with whatever the VA sends me on needles and meds....Not complaining, it's a very low co-pay and I'm lucky to have the service.

[2ndovc]

Ahh, now we get to an area of my expertise.

First use the prefilled injectors. I use one called Humulin. The needles that work with it are short and very fine. Unless you do hit a nerve, and you can't always avoid that, their isn't any pain.

When preparing the skin for the injection use those little prewetted alcohol swabs. Clean the area well, and here's the tip, let the alcohol dry for a few seconds. I think most of what you end up feeling is the sting of the alcohol when you break the skin.

I find the abdomen to be a good place. Not that many nerve endings compared to other places. And in my case, there's a fair amount of real estate. Try to avoid using the same general area repeatedly. The front of the thighs seems to work well also.

Also, don't be tentative. Stick it in, inject, wait a couple of seconds and pull it out. (I just realized how that sounds. Get your minds out of the gutter).

I really hate to say this, but U-tube has a lot of videos. And after about a week you'll be an old pro.

I had this come about two years ago. Diabetes is pretty rare in my family but it just happens, I guess. I can't do the stomach thing but alternate from hip to hip every evening. Most of the time, there isn't any pain. Like you said, just stick it and go. I freaked out a bit when I was first told I had I but my Doc reminded about all the Stuff I've been through and this wasn't a big deal. I started with a blood sugar count of 564! When I test myself in the evenings I'm usually around 110. Last A1C was around 5. Had a harder time avoiding the carbs than the sugar. Except, I'd kill for a big cold glass of Coke!

jb

[Beaker]

We use daily subcutaneous shots for testosterone instead of weekly imtramuscular ones; they hurt so much less that patients can self-administer easily.

Can You please elaborate more on this? Due to a massive prolactinoma tumor in my pituitary gland, I produce no natural testosterone. I have used the gels with little success and the intramuscular injections, as you say, hurt! those 2.5 inch long 18 or 21ga needles are not fun. I have not heard of a daily injection or found one in my research on this, so I am obviously quite interested in this. It sounds like it is much less painful and could be done by myself instead of having someone else inject me.

[AJMD429]

We prescribe "testosterone cypionate 200mg/cc - ' up to 2 cc weekly'" - so the patient can hopefully get eight 1cc vials per month. They will use less, but it minimizes co-pays and trips to the pharmacy. The vials will get 5 to 10 small needle-pokes, so with proper alcohol-swabbing can remain uncontaminated nicely - using the large 10cc vials for DAILY dosing would mean LOTS of holes over up to several months, and I don't recommend it.

The NORMAL way is intramuscular and the vials will say on them "for intramuscular use only", but apparently this is to prevent intraVENOUS administration, which could be dangerous (oily embolus to the lung). Actually, even when intending to administer intramuscularly, and even when the injector properly draws back the plunger to check for blood in the needle-hub, sometimes it happens (and many people forget or don't know to do that check).

We also prescribe 1/2cc 29 gauge insulin syringes for 'use daily as directed'.

We don't directly connect the two prescriptions (i.e. say what to put in the syringes, or what syringes to use to administer the testosterone), but we DO give a handout to the patient explaining that this isn't the 'normal' way to give the medication, and we encourage them to show it to the pharmacist so they realize we are doing this intentionally. The INSURANCE often balks, as it isn't the normal route of administration, but with GoodRx you can get the medication for around $30-40 a month and the syringes are dirt cheap, so most people aren't even bothering to use insurance.

From all I've read, there is smoother levels, and near-zero pain, versus the intramuscular, and perhaps that may even result in less side effects. One problem with the gels is that the subcutaneous tissue they have to travel through and be absorbed by contains fat cells which do convert testosterone to estrogen, and this is probably going to happen with the subcutaneous injections. HOWEVER, regardless of how the testosterone is administered, estrogen levels should ALWAYS be monitored; slowing the conversion is very easy with a tiny dose of anastrozole like 1 mg weekly or so. High (or too low) estrogen is not good for men in terms of prostate, clotty blood, or mood. The only real issue I see in the medical literature is "a slight increase in the number of sterile abscesses at the site of injection", which is probably related to people not evacuating air bubbles or something - I've not ever seen that, and if it happens it is a no-big-deal 'side effect' anyway.

Most pharmacists are interested in the way we do it, and happy to go along with it once we explain that we aren't just doing it by accident, and that we have done our homework before prescribing something for subcutaneous use that says "for intramuscular use only" on the vial, as well as using a "single dose" vial for several posts; there are reasons those vials are so-labeled (no preservative) so sterile technique is especially important. They just want to make sure we aren't doing something stupid and dragging them in to it. Occasionally, there will be a pharmacist (probably a nervous new graduate) that is too uncomfortable with the process, but they eventually go along with it.

There is a commercial product that uses a whole cc of subcutaneous testosterone enanthate in sesame oil (Xyosted) at around 75 to 150 mg per once-weekly injection, and pointing that out reassures them a bit as far as the 'subcutaneous' part. The testosterone cypionate in grapeseed oil we are using is absorbed a bit faster from what I understand, and would probably not be a good choice for once weekly subcutaneously. We actually use Xyosted quite often IF insurance covers it, but it is quite expensive ($500 or so per month) if you have to pay full price for it.

Many insurers reject coverage if the testosterone level is "in the normal range" but they twist reality and use the REFERENCE range provided by the lab as the 'normal' range, and all the 'reference' range is, is the cutoff points for the highest 2.5% of the population and the lowest 2.5% of the population, at least with most labs - this says NOTHING whatsoever about who should be treated. Out of 1,000 people, that would mean only treating 25 for 'low' testosterone, and assuming there were 25 who had unnaturally 'high' testosterone, which would be very strange. With men over 50, probably out of 1,000 patients, probably 100 would benefit from testosterone, not just 25, and the highest 2.5% probably don't have some testosterone-secreting tumor or medical issue that needs fixed. God didn't give us an Owners Manual, so we really don't know what is 'normal' for ANYTHING - all we can do is measure stuff, correlate it with how people feel and do medically, and make inferences. Then we treat some of them and see what happens. Sounds kind of random and seat-of-the-pants, and most doctors won't admit it, but it is the reality, whether we are treating blood pressure, testosterone, or cholesterol. Using catch-phrases like "evidence-based medicine" to legitimize certain paths of treatment is just modern-day smoke-and-mirrors - most often used by insurance companies to deny treatment, or by physicians who would rather blindly follow protocols than actually individualize patient care.

The dose we use is usually between 0.1 cc and 0.2 cc daily, or 20-40 mg daily, and on an insulin syringe that appears as '10' units or '20' units. It is such a small volume you really don't feel the injection.

It is the drawing out of the vial that is s - s - s - l - l - l - o - o - o - w - w - w - !!!!
I count to 100 before even checking to see if any droplets are coming in to the syringe through that tiny 29 gauge needle. You certainly can spend way more money and draw it out with a 21 gauge or something, then swap needles to a 26 or whatever LuerLok is the tiniest you can find, but it involves more cost, more needle switching, which adds time, and increases risk of breach of sterility, and wastes more medication in the hubs, as well as reducing dose accuracy. We just tell patients to BE PATIENT and the grapeseed oil (most testosterone cypionate is in that oil) will draw into the 29 gauge needle.

See if your doctor is willing to try it. I can't think of a downside. Less pain, less cost, more accuracy, smoother levels....!

[Beaker]

We prescribe "testosterone cypionate 200mg/cc - ' up to 2 cc weekly'" - so the patient can hopefully get eight 1cc vials per month. They will use less, but it minimizes co-pays and trips to the pharmacy. The vials will get 5 to 10 small needle-pokes, so with proper alcohol-swabbing can remain uncontaminated nicely - using the large 10cc vials for DAILY dosing would mean LOTS of holes over up to several months, and I don't recommend it.

The NORMAL way is intramuscular and the vials will say on them "for intramuscular use only", but apparently this is to prevent intraVENOUS administration, which could be dangerous (oily embolus to the lung). Actually, even when intending to administer intramuscularly, and even when the injector properly draws back the plunger to check for blood in the needle-hub, sometimes it happens (and many people forget or don't know to do that check).

We also prescribe 1/2cc 29 gauge insulin syringes for 'use daily as directed'.

We don't directly connect the two prescriptions (i.e. say what to put in the syringes, or what syringes to use to administer the testosterone), but we DO give a handout to the patient explaining that this isn't the 'normal' way to give the medication, and we encourage them to show it to the pharmacist so they realize we are doing this intentionally. The INSURANCE often balks, as it isn't the normal route of administration, but with GoodRx you can get the medication for around $30-40 a month and the syringes are dirt cheap, so most people aren't even bothering to use insurance.

From all I've read, there is smoother levels, and near-zero pain, versus the intramuscular, and perhaps that may even result in less side effects. One problem with the gels is that the subcutaneous tissue they have to travel through and be absorbed by contains fat cells which do convert testosterone to estrogen, and this is probably going to happen with the subcutaneous injections. HOWEVER, regardless of how the testosterone is administered, estrogen levels should ALWAYS be monitored; slowing the conversion is very easy with a tiny dose of anastrozole like 1 mg weekly or so. High (or too low) estrogen is not good for men in terms of prostate, clotty blood, or mood. The only real issue I see in the medical literature is "a slight increase in the number of sterile abscesses at the site of injection", which is probably related to people not evacuating air bubbles or something - I've not ever seen that, and if it happens it is a no-big-deal 'side effect' anyway.

Most pharmacists are interested in the way we do it, and happy to go along with it once we explain that we aren't just doing it by accident, and that we have done our homework before prescribing something for subcutaneous use that says "for intramuscular use only" on the vial, as well as using a "single dose" vial for several posts; there are reasons those vials are so-labeled (no preservative) so sterile technique is especially important. They just want to make sure we aren't doing something stupid and dragging them in to it. Occasionally, there will be a pharmacist (probably a nervous new graduate) that is too uncomfortable with the process, but they eventually go along with it.

There is a commercial product that uses a whole cc of subcutaneous testosterone enanthate in sesame oil (Xyosted) at around 75 to 150 mg per once-weekly injection, and pointing that out reassures them a bit as far as the 'subcutaneous' part. The testosterone cypionate in grapeseed oil we are using is absorbed a bit faster from what I understand, and would probably not be a good choice for once weekly subcutaneously. We actually use Xyosted quite often IF insurance covers it, but it is quite expensive ($500 or so per month) if you have to pay full price for it.

Many insurers reject coverage if the testosterone level is "in the normal range" but they twist reality and use the REFERENCE range provided by the lab as the 'normal' range, and all the 'reference' range is, is the cutoff points for the highest 2.5% of the population and the lowest 2.5% of the population, at least with most labs - this says NOTHING whatsoever about who should be treated. Out of 1,000 people, that would mean only treating 25 for 'low' testosterone, and assuming there were 25 who had unnaturally 'high' testosterone, which would be very strange. With men over 50, probably out of 1,000 patients, probably 100 would benefit from testosterone, not just 25, and the highest 2.5% probably don't have some testosterone-secreting tumor or medical issue that needs fixed. God didn't give us an Owners Manual, so we really don't know what is 'normal' for ANYTHING - all we can do is measure stuff, correlate it with how people feel and do medically, and make inferences. Then we treat some of them and see what happens. Sounds kind of random and seat-of-the-pants, and most doctors won't admit it, but it is the reality, whether we are treating blood pressure, testosterone, or cholesterol. Using catch-phrases like "evidence-based medicine" to legitimize certain paths of treatment is just modern-day smoke-and-mirrors - most often used by insurance companies to deny treatment, or by physicians who would rather blindly follow protocols than actually individualize patient care.

The dose we use is usually between 0.1 cc and 0.2 cc daily, or 20-40 mg daily, and on an insulin syringe that appears as '10' units or '20' units. It is such a small volume you really don't feel the injection.

It is the drawing out of the vial that is s - s - s - l - l - l - o - o - o - w - w - w - !!!!
I count to 100 before even checking to see if any droplets are coming in to the syringe through that tiny 29 gauge needle. You certainly can spend way more money and draw it out with a 21 gauge or something, then swap needles to a 26 or whatever LuerLok is the tiniest you can find, but it involves more cost, more needle switching, which adds time, and increases risk of breach of sterility, and wastes more medication in the hubs, as well as reducing dose accuracy. We just tell patients to BE PATIENT and the grapeseed oil (most testosterone cypionate is in that oil) will draw into the 29 gauge needle.

See if your doctor is willing to try it. I can't think of a downside. Less pain, less cost, more accuracy, smoother levels....!

Thanks for the information!

[piller]

I wish I had kept my class notes from my Professor who was infecting people with Islet cells with a virus that attacks the liver. I don't remember the virus, nor do I remember how he clipped the viral RNA at the right spot. Eli Lilley Company was footing the bill. After 5 years and over 100 type 1 diabetics cured, the plug got pulled and all the research was locked away. Failure rate of less than 1 percent. I wonder if my reaction to Ciprofloxacin that destroyed body's ability to produce insulin could be fixed with his virus.