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Dear Dr. Young, I just read the Summer ’92 issue and I couldn’t believe what I read in your column. You advised against rotating injection sites. My boyfriend’s mother has had Type I diabetes for 16 years now and had always given her shots in her stomach. Well one day her stomach started to swell up. She went to the doctor and he couldn’t believe that she didn’t rotate her injection sites. The insulin hadn’t been able to penetrate scar tissue. After this change, not only did her stomach return to normal, but her blood sugars improved-at half her old dose.

So as you can tell, I am very adamantly against injecting in one area. I rotate using my arms, stomach, and legs, and although there’s a change in absorption rate, that can be controlled by how early you take a shot before eating.

Carrie L. Knight
Anchorage, Alaska

Dear Carrie,

It seems that my last column has raised some controversy. It is quite correct that, if an area of injection develops lipo-hypertophy (a build up of fat tissue at the injection site that will feel hard and firm), lipo-atrophy (a hollowing out or loss of fat at the injection site), or scarring at the injection site, then these areas should be avoided wherever they may be. Actually, one need not rotate the injection site, but just avoid the hypertrophied or atrophied areas.

In regards to the timing of insulin injections, generally speaking, insulin injected into the abdomen is absorbed much more quickly than insulin injected into the leg. If one is forced to use the leg injection site because of abdominal scarring, then one would have to give their injection an hour earlier than the abdominal injection.

Many patients do not have the convenience of being able to give their injection so soon before a meal. Generally, I tell patients to check their blood sugar an hour before meals if possible. If the blood sugar is greater than 200, then taking the injection at that time would be helpful in getting the blood sugar down prior to the meal. If the blood sugar is in a more normal range, between 80 and 180, then the usual 20 to 30 minutes before meals would be appropriate.

Thanks for your letter,

Clinton Young MD

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