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All diabetics know that you should inject insulin into the fatty tissue under the skin (subcutaneously) and rotate your injection sites. Antiseptics make the skin hard and the injections sore and so they are best avoided provided your skin is clean. However, people can become so intent on the details of insulin dose adjustment that they forget that one reason why their diabetes is hard to control may be the injection site.

Dents and lumps
Nowadays fewer diabetics are taking beef insulin. Most people coming to our clinic take human insulin and the others take highly purified pork insulins. Few use beef insulin. One of the problems with the old beef insulins was fat atrophy (tissue loss) or hypertrophy (tissue gain) at the injection site. These dents and lumps in the thighs or arms can be very unsightly and may also affect the absorption of insulin from that site. Fat atrophy and hypertrophy are considered to be allergic reactions to the insulin and are less common on highly purified human or pork insulins, though they do occur. You can probably lose dents and lumps by changing to human or highly purified pork insulin, if you are not already taking it, and injecting this into the edge of the abnormal area, gradually moving in towards the middle as the problem is resolved. However, it has to be said that this may not cure everyone. The best way to prevent dents and lumps occurring is to rotate your injection sites so that no area is overused.
Ten years ago I met Albert, sixty-three years old, who had been admitted to the hospital because his blood glucose was very poorly controlled. When I examined him I discovered two little black holes, one on the front of each thigh. This was where he had been injecting his insulin for the past five years! Many diabetics have a favourite area for insulin injections, easy to h and a little numb from years of injections. That is how insulin atrophy and hypertrophy develop.

Red spots and bruises
It is not unusual for new diabetics to find little d spots at the site of recent insulin injections. This normally settles down after a few months. But persistent sore red spots or lumps may mean that you are allergic to your current insulin or to the zinc in it. A single very tender lump, which may or may not be red to start with, may be an injection site abscess. This may need lancing and/or antibiotic treatment by your doctor. Bruising at the injection site should not occur very often. If it does, you may be going in too deep. Avoid piercing veins near the surface – you can see them as
blue lines.

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When Gary Krajewski was ten, he suddenly started losing weight. Within a few months he dropped from a husky 117 pounds to only 85 pounds. He felt tired and run-down. He was constantly thirsty, and he kept asking for candy and other sweets. When Gary’s worried parents took him to the doctor, his problem was quickly diagnosed: He had diabetes.
LeeAnn Redfern, one of the nurses who helped to teach Gary how to keep his diabetes under control, knew just how he felt. She was diagnosed with the disease when she was eighteen.
Kathy Konopack, a young mother in a nearby town, supervises her seven-year-old son David when he gives himself insulin injections to keep his diabetes under control. “It doesn’t affect me the way it might affect other mothers to see him give himself shots,” she comments, “because I know that if he didn’t he wouldn’t be here.” Kathy has diabetes, too, diagnosed when she was a child. Like his mother, David has adjusted to the routine and is living an active life. “David plays baseball, plays with all the other kids, and we go bowling every week,” Kathy says.
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