This content originally appeared on diaTribe. Republished with permission.

By April Hopcroft

Whether you use syringes or insulin pens, injections can be a pain – literally. Here are techniques and tips to make injections as seamless as possible. 

There are many ways to take insulin, including syringes, prefilled pens, or insulin pumps. How you take insulin is highly personal – different people have different dosage needs, timing, and preferences.

If you take insulin through injections, it’s important to choose and rotate injection sites properly and follow recommended steps to ensure safety. Shelly Milsted, a certified diabetes care and education specialist (CDCES) at the University of Maryland Baltimore Washington Medical Center, offers some helpful tips to make injections a breeze.

Choosing an injection site

When choosing where to inject insulin, always examine your skin carefully. Avoid injecting into damaged skin, such as scars, irritation, wounds, or stretch marks. If you’re injecting insulin to a site on your stomach, be sure to stay one inch away from the belly button on all sides.

It’s also important to avoid injecting into the same area repeatedly. As a general rule, Milsted recommends injecting at least one finger’s distance away from the last injection site.

This distance helps prevent what’s called lipohypertrophy, which is when skin becomes lumpy and can’t absorb insulin as well due to injecting too often in the same spot. This can make insulin less effective and could potentially impact diabetes management.

There are several strategies you can use to change up your injection sites:

Imagine there’s a clock at the injection site. Start by placing the injection in the 12 o’clock position, then switch to 3 o’clock, 6 o’clock, and so on.
Visualize the letter M or W and use each point of the letter as an injection point.
Map out a grid pattern (2×2, 3×3, and 4×4 work well) onto the body part where you’re injecting. Start with one grid quadrant and gradually rotate injections through all the boxes.

Steps for insulin injections

1. Gather supplies

Make sure you have everything you need before you start. This includes the insulin vial and syringe or injection pen, handwashing supplies, alcohol wipes, and a sharps container for safe disposal of syringes.

It’s a good idea to keep the insulin you’re currently using at room temperature. While it’s good practice to keep all unopened insulin vials in the fridge, it’s worth noting that cold insulin taken directly from the fridge may sting or burn when injected, Milsted noted.

Milsted also said that the “out of sight, out of mind” mindset can play a role in missed insulin doses. “It’s visually helpful to have your insulin out at room temperature, where you’ll see it and know you need to take it,” she explained.

2. Choose the shortest needle length

Always use the shortest needle length (4 mm for pens and 6 mm for syringes) to minimize discomfort and make sure that insulin is absorbed consistently.

3. Wash your hands and clean the injection site

Always wash your hands or use hand sanitizer before injecting insulin to prevent infections at the injection site. Then disinfect the injection site using an alcohol swab or wipe.

4. Prepare a syringe or injection pen

If you’re using syringes, use a fresh needle for each injection since sharp needles reduce pain and trauma to the skin. Insulin injection pens are multi-use devices. Each pen provides a specific amount of insulin: for instance, the Tresiba and Novolog U100 pens contain 300 units of insulin.

Draw up the correct amount of insulin into the syringe or dial your insulin dose on the pen according to instructions from your healthcare provider.

5. Inject into the fat layer under the skin

Insulin should be injected into the fatty layer just below your skin – this is called a subcutaneous injection. If you inject too deeply, the insulin can enter your muscles and be absorbed too fast; this situation can cause low blood sugar (hypoglycemia). Plus, injecting into the muscle is generally more painful.

Before you inject, relax the muscles in the area you’re injecting to make nerves less sensitive – it may help to take deep breaths or sit down. When you’re ready, insert the needle straight into your skin (at 90 degrees) with a quick, smooth motion. Avoid applying too much pressure, so you don’t force the needle into the muscle below the fatty layer.

If you have limited body fat, pinching the area and injecting diagonally (at a 45 degree angle) is a good idea to prevent injecting into the muscle. Pull the needle out of your skin and release your skin pinch after injecting.

6. Dispose of needles safely

Do not reuse needles. Use a hard plastic container, sharps box, or medicine bottle to properly dispose of the used needle(s). Proper disposal of sharps may vary based on where you live – be sure to check your state’s guidelines.

Pen needles are “one and done” products that should be disposed of immediately after use.

“Avoid keeping used pen needles on, as the insulin may crystallize and bacteria could get inside the injection pen,” Milsted said.

Where to get additional help

A diabetes educator (such as a CDCES) can be a great resource for any questions or concerns you have about injections. CDCESs can help you overcome a fear of needles and master injection techniques – some may even help you practice on a mock injection pad.

Depending on your insulin dose timing, Milsted said you might even be able to give yourself an injection at an appointment with a diabetes educator. That way, they can observe your injection technique and provide feedback in the moment.

Milsted advised against practicing injections at home even if you have something you can use as a mock injection pad. Instead, she suggested scheduling a visit with a healthcare provider or diabetes educator.

What if you know how to give yourself an injection, but don’t like looking at needles? There are many technologies and devices that may be helpful for this. For instance, several companies make special shields to hide the needle, which can be helpful if you have a fear of needles. However, Milsted noted that insurance doesn’t always cover these products and advised reaching out to your insurance plan ahead of time.

If you’re having trouble keeping track of your insulin doses, consider trying a smart pen. These devices can calculate the appropriate insulin dose, track the time and amount of each dose, remind you when it’s time for your next dose, and tell you when your insulin has expired. There are also many apps available to track your insulin doses, such as Glooko and mySugar.

If insulin injections aren’t working for you, schedule a meeting with your healthcare provider to discuss alternatives, such as inhaled insulin or an insulin pump.

The bottom line

While injecting insulin can feel daunting, there are many different resources to help you master the technique. You can seek one-on-one support from your healthcare provider or a CDCES, while diabetes self-management education (DSMES) classes allow you to learn with others in a group setting.

Ultimately, Milsted said after the first injection, people tend to realize it’s not so bad – especially with modern technology, needles are now very small and discrete. “Most people just need to inject once to say ‘Oh that wasn’t bad,’ because the needles are so short these days,” she added.

Learn more about insulin therapy here: 

Switching Away From Levemir: What Are the Options?
Taking a Break From Your Insulin Pump
Getting Started with Insulin if You Have Type 2 Diabetes