Last month I gave you a basic background on insulin and it's actions in the human body pertaining to muscle tissue.
This month, with the second in a series of four articles on insulin use in bodybuilding, I'll show you where to properly inject insulin and the proper method of preparing and injecting insulin.
Please notice I've not yet explained what type of insulin to use, when to inject it or what foods to eat post-injection. As I've mentioned before, insulin is far more dangerous than steroids, and as such should not be taken lightly. By learning how insulin works and how to properly inject it first, it's my hope that the reader will have a basic working knowledge of insulin before being shown the finer details; which I will cover in the next two issues of Ironmag.
Disclaimer: This article is for entertainment purposes only. DO NOT follow any of the advice given in this article without the supervision of a trained medical professional. Ironmag.com accepts no responsibility for the actions of anyone reading this article.
Insulin Syringes
Insulin syringes in the three basic capacities of 1 cc (100 units), 1/2 cc (50 units), and 3/10 cc (30 units) are the most common. The unit scale or graduations on the barrel of the syringe may differ depending on the size of the syringe and the manufacturer, with 1 cc syringes usually marked in 2-unit intervals and 1/2 cc and 3/10 cc syringes in 1-unit intervals.
Insulin syringes are also fitted with different needle gauges and lengths ranging from 28G (BD Micro-fine™, Terumo Sure Dose™), 29G (BD Ultra-fine™, Terumo Sure Dose Plus™) and 30G (BD Ultra-fine II™). As with other needles, the higher the number of the needle gauge, the smaller the diameter of the needle. In general, most bodybuilders prefer the thinner needles, associating thinner needles with greater comfort. Be warned though that with the thinner gauge needle also comes increased needle flexibility.
Insulin syringe needles are available in the standard 1/2-inch (12.7mm) and a shorter 5/16-inch (8 mm) that is often perceived as less intimidating to the needle-phobic and new insulin user. If you decide to change your needle length you may experience a change in glycemic control, as absorption from a different subcutaneous depth can affect rate and extent of insulin absorption. Be aware. If you are contemplating changing needle length should do so only with professional guidance and be encouraged to monitor blood glucose levels carefully. I recommend using the standard 1/2-inch mostly for its improved glycemic control.
Insulin Injection Sites
Insulin is injected into the fatty tissue under the skin from which it is absorbed into the blood stream at rates that vary with the site of injection, so blood glucose values may also vary with injection site. Absorption is most rapid from sites in the abdomen, somewhat slower from the arms, slower still from the legs, and slowest from the hip or ass area. Patients may choose one area over others because of comfort, or how quickly or slowly insulin is absorbed. Rotating injection sites within one area is generally recommended over rotating to a different area due to the variable absorption between the different sites. Increasing exercise of the injection site increases the rate of insulin absorption by enhancing blood flow to the area. Preferred sites for insulin injections include the upper arm, the anterior and lateral aspects of the thigh, the buttocks, and the abdomen (stomach area).
Rotation of injection sites is critical to help maintain the health of skin, fat, and muscle tissues repeatedly subjected to the insult of injection. Lipohypertrophy and lipoatrophy (lipodystrophies) are both associated with subcutaneous insulin injection, but lipoatrophy (localized wasting of fatty tissues at injection sites) is more closely associated with insulin impurities. The incidence of is rarely seen today with human or even purified animal insulins.
Insulin promotes the growth of adipocytes, though, especially in abdominal areas where adipocytes tend to be more responsive to such a stimulus than other areas. It enhances lipogenesis, increases protein synthesis, and inhibits lipolysis and free fatty acid release from adipose tissues. Thus, lipohypertrophy, as a cellular response to insulin, continues to be a problem for the patient with diabetes who uses insulin. A lipohypertrophic area may become a less painful injection site and thus encourage regular use, but this practice should be discouraged for obvious reasons.
Continued injection to the lipohypertrophic site can affect the predictability of insulin absorption, especially if conversion to fibrous tissue has taken place. Since continued and prolonged exposure to insulin is recognized as a major risk factor for lipohypertrophy, site rotation is an important preventive measure, as is the use of shorter-acting insulin analogs. It is logically speculated that minimizing tissue damage by using needles only once may also be an important preventive factor. Though certain individuals seem particularly susceptible to developing lipohypertrophy even with rigorous attention to site rotation, others seem equally resistant to this problem regardless of repeated use of a single site.
Common Insulin Injection Sites
Preparing a Dose for Injection
1. Wash hands with warm, soapy water prior to the procedure.
2. Gently mix the insulin. You can mix it by rolling the bottle between the palms of your hands, by turning the bottle over from end to end a few times, or by shaking the bottle gently.
3. If this is a new bottle, remove the flat, colored cap. Do not remove the rubber stopper or the metal band under the cap.
5. Push the needle through the rubber stopper of the insulin vial, and push the air in the syringe into the bottle of insulin.
6. Hold the vial stopper-down with one hand, and pull down slowly on the plunger with the other hand to draw insulin into the syringe, until the top of the plunger lies on the correct measure needed for injection.
8. If air bubbles appear in the syringe, push the insulin back into the vial and again, slowly draw insulin into the syringe to the proper volume. The syringe may also be gently tapped with the finger to remove air bubbles. Repeat this until there are no air bubbles and the correct number of units of insulin is within the syringe. Though tiny air bubbles are not dangerous, they can reduce the volume of insulin in the injected dose.
Injection
2. Clean the skin at that place with an alcohol swab
3. "Pinch" up a large area of skin. Push the needle into the skin, going straight in (at a 90° angle). Be sure the needle is all the way in.
5. Pull the needle straight out. Don't rub the place where you gave your shot.
Tips to Minimize Injection Pain
- Inject insulin at room temperature.
- Remove all air bubbles from the syringe before injection.
- Wait until topical alcohol has evaporated before injecting.
- Keep muscles in the injection area relaxed during injection.
- Penetrate the skin quickly.
- Avoid changing direction of the needle during insertion or removal.
- Do not reuse disposable needles.
By following the techniques outlined above, you should avoid any infections or injection related problems when injecting insulin.
Next month we'll get into exactly what types of insulin to use, when to inject
it and what foods and supplements to take along with your insulin to maximize
muscle growth and minimize fat storage. 
References:
American Diabetes Association. Insulin administration. Diabetes Care. 1999; 22 (suppl 1): S83-S86.
Williams BS. Insulin injection devices: practical considerations. Diabetes Certificate Program. 1998.
Insulin Storage. Documentation from Eli Lilly Medical Information Services, US Medical Division, Accessed 10/15/99.
Information for healthcare professionals, BD Diabetes Products. BD Diabetes Village. www.bd.com/diabetes. 10/17/99.
Glucose control and shorter length pen needles. Clinical trial summary. Becton Dickinson. 1996.
Shaw LK. Improper insulin injection induces unsightly lumps. PowerGraphs. 1999;3(9):2.
Cranor C. Outcomes of the Asheville diabetes care project. Pharmacy Times. 1998; suppl:19-24.