Last week, I introduced the topic of insulin absorption. I laid out the basics, and then gave a nice, cheery list of all the things that can go wrong with how our bodies handle incoming insulin. This week, we’ll revisit that list and talk about some strategies for managing this issue.
The first issue we went over last week was site selection. For both infusion sites and for shots, this is very, very important. Repeated use of a single site leads to the buildup of scar tissue, another issue I highlighted last week. Over time this scar tissue can impede insulin absorption so badly that an area of your body simply becomes “unusable” for taking in insulin. Scar tissue CAN heal over time, but areas with severely built up scar tissue can take years to recover and become absorbent again. The better solution is to avoid developing scar tissue in the first place (as much as possible, at least).
Rotating our injection sites is key. The methods people use vary (some people have said they rotate their sites in the shape of a “W” on either side of the belly button, moving left to right across the belly, then moving on to the next are of the body and following a similar pattern there; others rotate in a clockwise circle around the belly button [at least 2 inches away], and so on). But there are a few general rules. When you move to a new site, it should be at least 2 inches from the last site, particularly for insulin pumps, as the previous area can become overly “saturated” with insulin, and so the next round of insulin needs to be far enough away to ensure a “clean” site. You should keep track of your rotation and follow a pattern — some people even use a “site journal” to log their sites (which can also help detect if certain areas absorb more slowly than others, since you’ll be able to see the correlation between where your site was and what your blood sugars did on a given day).
Another issue highlighted last week was making sure we are injecting insulin into the subcutaneous fat layer and not muscle. But in a maddening paradox, too much subcutaneous tissue can also be a problem. This is an area where using a continuous glucose monitor (CGM) can REALLY help. Assuming you avoid injecting into muscle (fairly easy to spot visually, and pinching up the skin helps ensure the shot is going into the fatty layer and not the muscle), we can use the CGM to see how quickly the insulin is affecting us. It might mean waiting a bit longer before we eat if we see the site we’ve just used is a little slower, but this is a small trade-off for better blood sugar results.
Something else that you can do when you see a site is slowly absorbing is to massage the area where the insulin was injected (at least if you’re using shots — with an infusion site, this is probably a bad idea as it could kink the cannula). This always sounded like an old wives’ tale to me, but I’ve seen it work. Massaging the area around the injection does seem to speed up absorption. In my case, I almost always massage the area for 20 seconds or so right after I inject because I know my general absorption tends to be a little on the slow side. For others, doing this might be a bad idea as absorption could be sped up TOO much. Again, a CGM is a magical tool to help you see if massaging the injection site is a good idea for you.
Lastly, I talked about the impact activity levels can have on our insulin absorption. Now, I want to make a distinction here between insulin absorption rate and insulin potency. Activity increases both. The potency is handled by adjusting your ratios, lowering your basal rate if you use a pump, or taking IN some carbohydrates before exercising if you use injections. The absorption rate is handled by how we time our injections or boluses. For instance, if I just finished a 45-minute bike ride, and I’m about to eat lunch, I will obviously change my ratios. But I will also probably take my insulin after the meal, or maybe partway through the meal, rather than taking it before I eat as I normally would.
As anyone living with diabetes knows, you could follow every bit of advice the world has to offer and still there will be days when the numbers just don’t behave. Similarly, sometimes insulin is just not absorbing well. We might be under a lot of stress, we might be fighting off a bug and not know it yet, or any number of other factors. We can’t control everything. But following some of the guidelines above can help us live better day to day, and get us closer to where we want our blood sugars to be.
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