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Long Lost Member
aliasbirt
Total Posts: 4
Registered on: ‎12-07-2011

Preventing Scar Tissue

I am currently using pens for my lantus and humalog to maintain my blood sugars. I inject myself a minimum of 4 times a day. I use my stomach as my inject site but there is only a small area that I found has enough fatty tissue to make shots painless (usually). Where else could you recommend that I take my shots? I can already feel my stomach getting scar tissue build up. I hope to get a pump in the next few years and would rather there not be a lot of scar tissue on my stomach when I get one. Thanks for your suggestions.

 

Type 1, Diagnosed August 1st 2011

trisha01
Total Posts: 6,195
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Registered on: ‎10-31-2009

Re: Preventing Scar Tissue

[ Edited ]

aliasbirt wrote:

I am currently using pens for my lantus and humalog to maintain my blood sugars. I inject myself a minimum of 4 times a day. I use my stomach as my inject site but there is only a small area that I found has enough fatty tissue to make shots painless (usually). Where else could you recommend that I take my shots? I can already feel my stomach getting scar tissue build up. I hope to get a pump in the next few years and would rather there not be a lot of scar tissue on my stomach when I get one. Thanks for your suggestions.

 

Type 1, Diagnosed August 1st 2011


 

Hi there,

 

I use Novolog & Lantus pens sometimes, but I've never used the needles. I draw mine out with syringes. I just opened a pen needle ( I have a few on hand), to see how thick it is. It appears to be a much smaller gauge than my 31 gauge syringes. Whether the pen needles for your Humalog are the same size, I've no idea.

 

Can you pinch up any when you inject? That might help with any pain. You could also get a script for Emla cream, which I believe will numb the area. An ice cube will do the same thing. I inject only in my belly (7 -12x's daily) - I'm also immune to most pain. The only scar tissue I have is from one major surgery. A lot of folks inject into their thigh or upper arm. The only thing I inject into my upper arm, is the needle inserter for my cgm. This is much larger (28 gauge) than the syringe needle or the pen needle. I sit when I'm doing this, and crunch the upper arm against the table edge. This pinches it up enough to get some fatty tissue for injection. Also, breathing out, when injecting, helps. The needles are so small, I dont think you have to be too concerned about scar tissue.

 

Maybe some others will have different thoughts or ideas for you. Weekends are usually slow, so just check back every so often.

 

Trisha - edited for my usual reasons :smileyhappy:




Trisha

IDDM (Type 1 Autoimmune) 30+ years ~ Currently using MDI & Minimed CGM ~
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mollythed
Total Posts: 5,579
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Registered on: ‎10-31-2009

Re: Preventing Scar Tissue

[ Edited ]

What do you think causes the scarring?  Is it breaking the surface of the skin, or is it injecting a foreign substance into the fat tissue and letting it ooze around?

 

I wonder what size pen needles you are using.  The shorter the needles, the less likely you are to go through the fat layer and into the muscle behind the fat.  The magazine ads for BD brand needles point out that the original pen needles were 12mm long but their newest Ultra-Fine Nano needles are only 4mm long and 32 gauge thick.  I think most needles are 8mm nowadays.  Even my cheaper generic brand pen needles are only 6mm or about 1/4 inch long, and 31 gauge.  I'm thinking that with shorter finer needles, you may be able to use a much wider area of your abdomen without the pain that comes from going too deep, into the muscle and visit each piece of real estate less often, so it has more time to recover. 

 

I know a lot of people re-use needles to save money, but it seems to me that a fresh, sharp needle almost glides in by itself and causes less trauma to the skin than a gradually dulling needle that takes noticeably more effort to pierce the skin.


"Molly" (aka mollythed)
Type 2 diabetes diagnosed in 1995, now managed with Lantus, Humalog and Metformin; diet and exercise.
My husband and three adult sons also have type 2 diabetes.





Super Advisor
leehr
Total Posts: 2,179
Registered on: ‎11-01-2009

Re: Preventing Scar Tissue

HI!

 

I have used my abdomen for injections for many years; even do now with my pump. 

* I was careful to use every bit of the abdomen and other areas as possible.....  If we can develop a mental picture of switching areas of injections just a tad further in any direction  from the last inject - it can help.  

 

OTHER INJECTION SITES:  

* Abdomen: From far side to far side & up and down. .
* Upper Arms, *  Upper Thighs and - *area above the Waist line & below the lowest Rib (not usually mention but it works b/c I use this area to good advantage for my pump infusion site so why not for injections)??

 

* The smaller the needle the better for both pain and less scar tissue is liable to develop as suggested by Trisha and Pam.

* Not sure if you can just change the needle of a pen.

* If a new syringe and needle are used every time there is usally less pain and less scar tissue. The new needle is very sharp & not dulled by contact with tissue. Perhaps in time one becomes accustomed to injections and can use the needle twice; some use a needle multiple times.  Every additional injection with the same needles (syringe or pen) dulls the sharpness of the needle point!

* Regardless,  one should have  a few syringes to use - just in case. As most of us T1s who use syringes, pens or pumps have a supply of syringes.


Joan


* Type 1 Diagnosed for 56 years as of Nov 2013
* 50 Year Type 1 Medalist Award from Joslin Diabetes Clinic (Harvard Medical School)
* Medtronic Paradigm Revel 523 insulin pump as of March 2011
* Insulin: Humalog
* Food Allergies: milk, yeast, corn
* Hashimoto's thyroid disease
* A bit of arthritis
* One kidney due to benign Angiomyolipoma.
* Volunteer Community Disaster Co-Coordinator
* Hobbies/Interests: Wildlife Naturalists, artist, gardening, music
mollythed
Total Posts: 5,579
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Registered on: ‎10-31-2009

Re: Preventing Scar Tissue

Joan,

 

The business end of an insulin pen looks a lot like the cap on a vial of insulin, with the rubber center.  The pen needles, which are designed to be changed with each use, are like small bottlecaps with a needle poking out of the center.  When the bottlecap is twisted on to the end of the pen, it pierces the rubber like a syringe does when you fill it. 

 

At the other end of the pen there is a mechanism that allow the user to meter out the correct amount of insulin by controlling a plunger inside the cartridge. There is no need to insert air into the pen at any point.

 

Pushing the plunger forces the insulin out of the pen needle and into the body.  The needle goes straight in, all the way up to its hub, at a 90 degree angle.   The length of the needle controls how deep it goes.  Then after injecting, the bottlecap can be unscrewed from the pen, and the rubber reseals itself, just like a vial.

 

Of course, it's a little more complicated than that, and there are extra covers for the pen that protect the user from unwanted pricks to the fingers during the process of putting then needle on the pen and taking it off.

 

 


"Molly" (aka mollythed)
Type 2 diabetes diagnosed in 1995, now managed with Lantus, Humalog and Metformin; diet and exercise.
My husband and three adult sons also have type 2 diabetes.





Super Advisor
leehr
Total Posts: 2,179
Registered on: ‎11-01-2009

Re: Preventing Scar Tissue

[ Edited ]

Thanks Molly, I did use insulin pens for a few months about 7 years ago and had a great NP to help me. But could not really remember much about them anymore. (edited: removed sentence)   But from what you explained changing a pen needle is possible.   Glad that they work well for so many.  The insulin pump is what has saved me from some serious difficulty  as I guess my system has really been challenged after so many years as a T1.  My system has bounced back to an almost normal levels using the pump. Hooray!   We use what works for us  best as individual - Right! .  

 

Cheers,

Joan


* Type 1 Diagnosed for 56 years as of Nov 2013
* 50 Year Type 1 Medalist Award from Joslin Diabetes Clinic (Harvard Medical School)
* Medtronic Paradigm Revel 523 insulin pump as of March 2011
* Insulin: Humalog
* Food Allergies: milk, yeast, corn
* Hashimoto's thyroid disease
* A bit of arthritis
* One kidney due to benign Angiomyolipoma.
* Volunteer Community Disaster Co-Coordinator
* Hobbies/Interests: Wildlife Naturalists, artist, gardening, music
Frequent Responder
__bsc_
Total Posts: 621
Registered on: ‎05-26-2010

Re: Preventing Scar Tissue

[ Edited ]

With proper rotation of sites, there seems to be little reason for scar tissue to be an accumulate at a high rate.  Scaring is a byproduct of wound healing.  When you have a wound, fibroblasts quickly fill the wound releasing collagen.  Then over a period of time this collagen matrix is replaced with normal tissue.  If you give your injection site 2 weeks or more to heal you normally will not get any scarring.  Now this does not mean that you will never accumulate scar tissue just that it is not normal to accumulate scar tissue quickly if you have given all your sites proper time to heal.

 

Now I understand, if you are lean, it can be a challenge to inject properly.  Lantus in particular must be injected into your bodyfat layer.  So I always pinch.  It takes practice to grab just your bodyfat layer and not your muscle and not skin.  If you are routinely bruising, then you need to improve your injection technique.  And I have to be honest, it took me some months to get to the point where I could regularly inject and not be constantly walking around with bruises.  Bruises are a sign of an increased injury and you should avoid bruise sites even longer.

 

So rotate, rotate and rotate.  If you cannot remember your injection sites then you can come up with a coding system to help you remember your sites.  There are an infinite number of ways of doing this.  Some people use a picture and check off the use of the site.

 

ps. And another suggestion is to find the proper needle size.  I ended up with an 8mm.  I tried the shorter needles but found that I really did better pinching and using a longer needle.

Frequent Advisor
t1wayne
Total Posts: 930
Registered on: ‎10-30-2011

Re: Preventing Scar Tissue

Six months and developing scar tissue seems a tad too soon.  But if you're only using a small portion of your stomach, you're overusing the same area too much.  I take 2 to 4 shots per day.  For my basal shots, I use my upper left arm (opposite the shoulder) Monday am; lower left arm (above elbow, below shoulder level) Tues am; left thigh Wed am; upper right arm Thur am; lower right arm Fri am; right thigh Sat am; stomach on Sunday am's.  Other shots I simply choose a spot that isn't the that day's or the next am's basal site.  I've been doing this for almost 46 years, and I've not developed scar tissue, so it can be avoided.  As someone already noted, rotate, rotate, rotate.  You may want to shift to some of the sites I just listed, and you can add to that list the buttocks (it's just that I'm a wimp with respect to shots there), and give your stomach a break for a while.  Good Luck!  w.

Wayne T1 May 1966
MDI; 46u Lantus Basal
Advisor
Dragonstar
Total Posts: 995
Registered on: ‎11-01-2009

Re: Preventing Scar Tissue

Knew it was somewhere here..

 

Here's the chart Lilly co. has of areas for injections along with the list of the absortion speed.  Hope it gives you an idea of more areas to use so you don't get scar tissue building up.

 

http://www.lillydiabetes.com/Pages/insulin-injections.aspx

 

and here is what they were saying about the tip being less sharp if you reuse one.

 

http://www.bd.com/ca/diabetes/english/page.aspx?cat=14501&id=14766

 

 

 


Mother of Courtney, Dx'd Type 1 in 2006 at age 14.
Frequent Advisor
sunritef
Total Posts: 2,414
Registered on: ‎11-30-2009

Re: Preventing Scar Tissue

With the 5mm pen needles, you really don't need a lot of fat to inject.  I asked for the shortest needles when I started because I too had few places to inject. I later fount that I could use my backside for my basal.. then found I could use my upper thighs also... finally figured out how to use my tricep area on my arms.  In my log, I put an L or an R on each day.  I either use my left side or my right side that day... for shots and tests.   I'll tend to use my arms more in the summer when I have short sleeve shirts and my stomach more in the winter when access is restricted some.   Remember that pump cannulas are bigger than a pen needle and stay in longer. You need to find the right balance to give your body a shot (pun intended)

 

Now, for the scarring you have,,, what is making you say that?  Just curious if this group could come up with an alternative reason for the problems you are obviously facing.



You go to school to learn, not for a report card.
You use your meter to learn, not for a report card

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