How to Manage Multiple Daily Insulin Treatments for Your Type 2 Diabetes

Medically reviewed by Susan J. Bliss, RPh, MBA on June 15, 2016Written by Susan Weiner, MS, RDN, CDE, CDN on June 15, 2016
manage insulin treatments

Has taking insulin injections affected your daily routine? Some people with diabetes need more than one insulin injection every day to help control their blood glucose levels. This was once called “tight control” of diabetes but is now called multiple daily injections (MDI). Using MDI may help you manage your diabetes well, but it may seem to interfere with your schedule at home or work. Here are some simple strategies to help make managing MDI easier.

Checking your blood glucose

It’s important to check your blood sugar levels throughout the day when you’re using MDI. Using MDI is an option for people who aren’t comfortable using an insulin pump. Most people using MDI are taking long-acting basal insulin and rapid-acting insulin. People usually inject long-acting insulin once or twice per day, and they typically inject rapid-acting insulin with meals or food throughout the day.

By keeping a close eye on your blood sugar levels, you’ll be able to tell how different foods and activities impact your levels while taking MDI. A postprandial test is a blood sugar check you do after meals. You should take this test one to two hours after the start of your meal since this is when blood sugar spikes highest after eating.

Checking your blood sugar before and after meal, before and after exercise, or even before or after sleeping can help you detect patterns of highs or lows and troubleshoot problems. It’s also a good way to become more aware of changes in your blood sugar levels throughout the week or to at least get you to start checking more often.

Rotating your injection site

If you inject insulin three or more times per day, then it’s a good idea to rotate which injection site you use. Injecting in the same place can cause hard lumps or extra fat deposits to develop. This condition is called lipodystrophy, or damage to the subcutaneous fat layers. Lipodystrophy affects how your insulin works. Injecting in the same spot can also cause your insulin to be less effective.

Your body absorbs insulin at different speeds depending on where you inject. It's best to use the same part of the body for each of your daily injections consistently. A good rule of thumb is to rotate sites at least an inch with each injection. For example, don’t inject your lunch bolus dose in the abdomen on Monday and in the thigh on Tuesday. If you’ve picked the thigh for your evening injection, then continue to use the thigh for all of your evening injections.

Injecting insulin into the abdomen works fastest, while insulin injected into the buttocks works the slowest. If you’re taking a premeal injection, you may want to do it in the abdomen to quickly cover the carbohydrate content of your meal. If you’re taking insulin at night, you may want to choose the buttocks, upper arms, or thighs for a more gradual release.

Injecting do’s and don’ts

Always work with your doctor when you begin MDI. Together, you can figure out the best schedule for site rotations and a blood glucose testing schedule. Here are a few more do’s and don’ts for daily insulin injections.

Do’s

Stick to a rotation pattern

For example, if you’re injecting into your abdomen, start at the top of your abdomen. The next injection should be about an inch to the left. Keep on going, until you circle all the way back to the top.

Hold your syringe or pen properly

Hold your syringe or pen at a 90-degree angle, and place the tip of the needle on the skin. Press gently and inject with minimal pressure. If it hurts when you inject, be sure to move the rotation site and discuss this issue with your doctor.

Tell your doctor if you’re reusing syringes

Reusing syringes isn’t recommended. If cost is an issue, your doctor or pharmacist may be able to assist you with a lower cost product or recommend other forms of assistance.

Don’ts

Here are some things you shouldn’t do:

  • Don’t inject near moles or scars or too close to your bellybutton. Because the tissue is tough in those areas, you might compromise insulin absorption.
  • Don’t use rubbing alcohol to clean the skin before you do a finger stick or injection. It dries out your skin, and there’s no added benefit as long as you’ve cleaned your skin with soap and water.
  • Don’t inject into your inner thighs. Sometimes, your thighs rub together when you walk, which can further irritate the injection site.
  • Don’t inject into your leg if you’re planning to hike, go for a run, or take a long walk. Exercising can cause you to absorb insulin at a faster rate, and you may experience a low blood sugar during physical activity.

Storing your insulin

Check the insulin package insert because different insulin should be stored at different temperatures. If you keep your insulin in the refrigerator, arrange it so you can clearly see the expiration date.

Take a moment to look or inspect the bottle. Rapid-, short-, and long-acting insulins should be clear, but intermediate-acting insulin should look cloudy. If your insulin has any crystals or debris in it or looks cloudy, it could be expired or spoiled. When in doubt, throw it out!

Once you’ve opened the bottle, make sure to use it within the time recommended by the manufacturer, and write the date you opened the container on the label. Never store your insulin in the freezer or direct sunlight. Avoid storing insulin in extreme heat or cold.

Always keep a cap on the syringe you're not using when mixing insulin to keep track of which syringe you've used.

If you’re currently using MDI, you also may need to be prepared to inject in public. While that’s not a problem for many people with diabetes, it might be necessary to find a private place to inject or test your blood sugar during the day. You can use insulin pens discretely, and they may make it easier to carry the correct dose with you.

Remember to discuss all of these techniques and suggestions with your doctor. They’ll show you how to hold the syringe or pen correctly and answer all of your questions.

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