Diabetes Forecast

Do's and Don'ts of Injection Site Rotation

By Carole Fleck , ,

If your blood glucose levels are surprisingly unsteady, the culprit may not be your diet, medication, or fitness regimen. Those swings may be due to something entirely unexpected: your skin.

It’s recommended that you rotate your injection or infusion sites by moving to fresh, unused patches of skin. Otherwise, the damage to your skin tissue from unrelenting jabs could result in poor insulin absorption. The abdomen is the preferred injection site because it’s easy to see and reach. Alternate sites include the hips, upper buttocks, outer thighs, and backs of the upper arms.

Eric Johnson, MD, an associate professor in the Department of Family and Community Medicine at the University of North Dakota School of Medicine and Health Science, and a member of the American Diabetes Association’s Primary Care Advisory Group, says diminished insulin absorption can lead to elevated blood glucose and, if not corrected, diabetic ketoacidosis (DKA) in extreme cases. 

Avoid Injection Site Problems:


  • Move to a new injection region, such as your upper arms or abdomen, every week.
  • Rotate injection sites within body regions.
  • Inject about two inches from the previous site.
  • Keep track of your injection sites.
  • Use fresh syringes and pen needles.


  • Inject close to the belly button, or by moles or scars, because tougher tissue there affects insulin absorption.
  • Inject in your inner thighs—they have a large number of blood vessels and nerves, so the region can be painful and prone to bleeding.
  • Inject in the skin tissue over a muscle you’ll be exercising, such as your racquet arm if you’re playing tennis, because that may speed up absorption too much.

Lumps and Bumps

Use clean fingers to examine potential sites, gently feeling for lumps. If you feel a bump, if indentations have formed, or if you have difficulty inserting a needle, avoid that site. Have your provider examine any lumps or indentations you find. A comprehensive diabetes visit should include inspection of injection and infusion sites.

Moving Along

Change your insulin pump infusion set at least every three days. If you’re having problems with scar tissue, consider a different type of infusion set.



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