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Diabetes Forecast

The Healthy Living Magazine

Where Can I Find New Insertion Sites?

I've had type 1 diabetes for 28 years and have used an insulin pump for 14 years. I have trouble finding enough good infusion set insertion sites. I primarily stick to my stomach. What other sites could I use? Wes Barnes, Cary, North Carolina

Christy L. Parkin, MSN, RN, CDE, responds:

After years of pump therapy and/or injections, it can be a challenge to find choice "real estate" that offers good insulin absorption.

Click HERE for a PDF of this article to print and save.

What to Know: The abdomen is the preferred site for infusion set sites and injections. It is easy to see and reach, and offers the quickest absorption. Alternate sites tend to absorb insulin more slowly than the abdomen. Here are alternate sites:

Site Rotation Patterns

Clock

Crisscross

Curve

Horizontal

Zigzag
Imagine patterns on your abdomen, and choose a new site that's at least 2 inches from the previous one.
  • Hips and upper buttocks. Even lean people tend to have some extra padding in these spots. Although there is slower absorption here, these areas are good sites for people with low body fat.
  • Outer thighs. Absorption may be increased with activity, such as walking or running. The inner thighs aren't recommended because when the thighs rub against each other, the site can become irritated and at risk for infection. 
  • Back of the arms. You may have some extra tissue under the skin here, but the area is hard to reach, especially if two hands are required for insertion. Physical activity can increase the absorption from this location.
Injection and Insertion Sites
Recommended: Red
Alternate: Blue

Possible Solutions: Inserting too many infusion sets in the same spot over many years can lead to scarring and/or overgrowth of fatty tissue (known as lipohypertrophy), which can cause poor absorption of insulin. Poor absorption may delay the effect of the insulin or require you to use more. If you can feel or suspect damaged tissue under your skin, avoid using the area; it can take several months for the tissue to heal.

Make a plan to regularly use different sites to maintain good skin integrity. Site rotation is a systematic method of selecting various sites so that each one has a chance to fully heal before it is used again. There are several methods of site rotation (see "Site Rotation Patterns" or click here for a PDF of this article to print and save). Choose the method that works best for you.

New sites should be at least 2 inches away from a previous site (as well as 2 inches away from the belly button). Change your site every two or three days, depending on the type of cannula you use.

Takeaways: Experiment with some alternate locations to open up your options and keep your sites healthy. And change the infusion set at the first sign of pain, swelling, or redness to avoid tissue damage. Remember, the rule of thumb to live by to preserve your sites is: "When in doubt, change it out."

 
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