Injection woes for skinny folks

Hi FUD folks. Newbie T1/LADA question. I am doing MDI right now (Humalog before meals and Tresiba basal) and having a really hard time finding good sites and setting up a site rotation. Using standard 4mm needles and pens.

My main problem is that I’m too thin. That’s not a flex! I’m underweight because of the disease itself, plus some orthorexia and fear of eating, although being a runner contributes. So I can’t use much of my abdomen for shots. I can pinch the skin up but it’s middle-aged flesh, hence a bit flaccid. Bit tricky to get a good shot in. I sometimes get angry red spots after and seemingly poor results judging from the spikes.

I was overrelying on my love handle region for a while but don’t want to burn it out. I can use my glutes tolerably ok, but same concern. I do my basal in my thighs, although sites are a bit limited there too. Not sure how much extra lead time to give the Humalog with that region. I have been trying to use my triceps, but success is intermittent–the other night I did 2 units there that just seemed to go nowhere. Tricky to get a precise 90 degree insertion when you’re reaching across your own body.

Well, I guess you all get the picture. So, help?


How about the front, very top of your leg, just below where it connects to the body? If that works, you could rotate a few spots on each leg. That’s where I used to do MDI. I’m on OmniPod now and place it in rotation on my abdomen.


Hi @Trying – I can give that a shot (sorry!). About how long would you suggest waiting before the meal? I usually go between 12-15min for other locations, but thigh is supposed to take longer.


I hadn’t noticed a difference of pre-bolus time for upper thigh vs say abdomen. Pretty much the same time. For me (I’m on Omnipod now so don’t inject), I shoot (sorry!) for 15-30 minute pre-bolus unless I’m already low, then I eat when bolusing.


I have a similar issue. I lost 25 lb due to a rheumatoid arthritis drug and haven’t been able to gain it back. I do MDI. I have a couple of areas of lipohypertrophy on my stomach below my belly button from long-term use. I use the outside of my hips and my butt mostly now, and sometimes above my belly button.


Did you try the 8’s I gave you?

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@needlesandmath I used to use thighs and calves because my trunk was overly sensitive. Just be aware that large muscles can have faster absorbtion rates.


Hi @Eric I haven’t yet – I’m still too afraid of hitting muscle


Don’t be. Just be aware that the insulin works faster. This can actually be a good thing, especially when you are fighting a stubborn high. Alternatively, by injecting into large muscles and then using those muscles, you can wait much much longer after eating before bolusing for meals.

Prior to pumping, my preference was to bolus in muscles exclusively. Now that I pump, I place my infusion set 80% of the time in extremities so I can hit large muscles. I get better absorbtion than trunk areas which means faster onset times and better predictability.

@Eric has a fountain a knowledge that is backed by info that many of us without a college degree will never understand. Long short, he has our best intentions at heart and wants to help the FUD community at large. I personally have learned things both directly and indirectly from @Eric that have seriously impacted for the better how I manage my day to day diabetes. There are many many others here on this forum (far to many to mention personally so I apologize for not calling you all out by name - sorry) who have made contributions and blog posts that have helped this person understand what more than a decade of Drs, nutritionists, CDEs, etc never could.

@needlesandmath there is a monumental wealth a knowledge here at FUD if you want it. Unlike other blogs, we here actually give a damn, and if you don’t understand something just ask. Someone will come along and explain it terms that make sense (sometimes the discussions get sort of highbrow and you need a scientific degee or an interpreter).

Stick around, we have your back, hopefully you will trust us to have yours.


Hi @elver thanks much for this. I’ve only been doing MDI for about a month, so I’m very early in learning my way around. I agree that there’s tons of useful material contributed by community members here (shoutout as always to @Eric !). It’s a great and supportive group.

I’m doing exclusively prebolusing, trying to get my carb counting dialed in, so the post meal bolus info is something I will file away for until I get more bold with my eating and start to need more corrections. Just ballpark, any guess about how much faster a muscular injection would kick in though? I leave 15 minutes now from shot to first bite and that seems to work ok (when the damn shot takes at all). I realize there may be no answer here besides “just try it and see!”…


As always YDDMV, but I was always told to add 30 min for Humalog onset if injecting in the trunk. In large muscles that are being USED, that time can be cut in half or less.

@Eric could probably give you specific onset curves and graphs if desired


My experience with the 4mm when doing MDI is that I can whack a bolus in anywhere and it just works, well, it works as well as MDI ever works. There’s subcutaneous fat everywhere on our skin, with perhaps obvious exceptions; don’t try the eyeballs.

I don’t know about Tresiba’s mode of action. The traditional long-acting insulins (NPH) used a chemical reaction to tie the insulin to the skin, Lantus, Tresiba and their ilk just adsorp slower. That may require more fat.

There is no need to pinch the skin with 4mm needles - that is the point. Back in my youth I had 1/2" of 18 gauge needle and if I stuck that straight in I would hit bone. These days 4mm means straight in, no pinching.

You have other options. If you don’t smoke you might consider Afrezza for bolus. If you have issues with Tresiba look at the dose; I regard any dose over 6IU as dubious and not likely to work, but for long acting I can do Lantus morning and evening and just do 6IU each time. Smaller is better; think what flooding a single cell with insulin does for that cell’s life expectancy, doing long acting three times a day isn’t hard when MDI requires at least that.


@Elver – could you please give examples of where you’re placing infusion sites to go for improved absorption? Are you going for muscle? Which extremities/where? Trying to gather data in advance of a possible pump trial. Thanks so much! Jessica


@JessicaD I’m using 6mm steel sets in my thighs generally unless I can find an area with some fat. If I can, I’ll use a 30°nylon set. Most often for my thighs it’s steel sets. I rarely set on bottom of thighs for comfort reasons. For calves, I’ll use quick sets or 30° sets. For bicep and triceps I’ll use quick sets or 30° sets whichever is easier to deploy. I rotate areas frequently including side to side. I do use the love handle area, but the absorbtion there is not great for me.


Hi @jbowler thanks for sharing the perspective. My MDI trials have been less successful–it’s technically true that there’s subq fat everywhere (this was my endo’s comment as well), there are places on me where it’s pretty sparse. And I do find pinching necessary because, given the lack of underlying fat, the skin just hangs and it’s hard to get a clean injection rather than a tear. When I can hit a spot with fat that’s adequately vascularized, it works, but doing so consistently is what I’m trying to solve.

Afrezza is an interesting prospect. I may have to go that route at some point but I think I should try to get this right first. I’m not unhappy with the Tresiba so far. I only take 2 units/day, although it should probably be adjusted up to 3.

Darn, and I was hoping to perfect my Un Chien Andalou technique!


Hi @psfud123 ! Yeah, I’ve tried my triceps several times. I can manage it, but barely. I don’t have great control over where I land, and often come in well off 90 degrees. Depressing the plunger with my non-dominant hand is also hit or miss. It’s possible for sure, but getting a nice neat line going is beyond me. If there are tips for how to do this more effectively, I’d love to hear them.

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If you use a longer needle or an actual syringe then 90° won’t actually matter as much IMHO. Just my 2¢ based on opinion and personal usage and not on any actual scientific fact.


I inject for meals bc my skin and Omnipod only seem to get along for basal.

I rotate my injection sites left butt cheek grid pattern for a month, right butt cheek for a month, upper outer right thigh for two weeks, upper outer left thigh for two weeks.

I use 5mm needles but used to use 4mm. The nurse just couldn’t find the 4mm in her Rx drop down one time and was frustrated so she clicked on the 5s. That’s the only reason that I switched.

I hold the needle in place for a few extra seconds after injecting bc my legs are super prone to leaking. My skin there is fairly tough…I really don’t think it’s scar tissue. I think I just have tough skin. Which may be why my pods can’t do boluses for me. I don’t know.

My ass works better than my legs but I rotate anyway just to be cautious.

And if I’m traveling or out with friends, it gets awkward to do ass injections at the table so I use my abdomen then.

I’m super skinny. Not really by choice. But those areas have worked for me even when this disease had me 10 pounds lower than I am now.

The spikes suck…but I just watch for trends that last more than a day. It’s hard to conclude much based off of any one injection or any one meal. Sometimes I do everything just the same and it still does crazy things.

But you’re doing great and I hope you find some areas that work well!

(By the way, I talk about asses to everyone on here. So don’t get weird about that. There’s a GIF floating around here somewhere to that effect…@Eric?)


Actually, all you have to do is search for “butt podding” to find the comedy. Some of it is fairly raucus conversation and some is rather risky cartoons put to6by members of FUD at @T1Allison’s expense.


For the most part that’s true. But if you make it rain enough, she’ll do an ass jab for ya too.