Of the 3 administration routes we discussed in this thread, that order is correct, but if we add ID in the list, ID is the slowest. ID creates that med bubble just under the skin. It’s used for some vaccinations, and the TB tine test. Although it would have pretty rare use for insulin, I have used it on a very limited basis while waiting overnight for a pump replacement, or in case of infusion set failure, when other options weren’t as convenient.
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Yes.
Where did ID come from? And what is it???
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Intra-Dermal (ID) so not as deep as SubQ. I suspect it came from a doctor or a researcher. It should be slower to absorb than SubQ.
Thanks @Dc53705, I hadn’t ever heard that as an idea in reference to insulin injections. How long in your experience did it take for absorption?
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I wonder how many times I have done this by accident. I’m also curious how much longer it takes?
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Me too. A bit of testing may be in order.
I think the recommendation by endo’s toward shorter needles is just a silly safety attempt to prevent accidental IM.
13 mm used to be somewhat common, then 8mm. And then it went to 6mm and now those ridiculous 4mm’s. Those are horrible.
The 4’s are nowhere near as fast as the 8’s.
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I still use 8 mm or 12 mm pen tips. The few times I’ve tried 4 mm, the injection really stings. I haven’t paid attention to absorption speed, but just based on the stinging and inability to inject through clothing, I’m not a fan.
Interestingly, I’ve been using 5.5 mm infusion sets and just got sent a few 8 mm ones to see if they help with occlusion issues I’ve been having. I wonder whether the longer needles will actually make the insulin work faster…?
I think so!
I have quite a bit of experience with IV insulin in the clinical setting. It is the route of choice when faced with someone who is dangerously hyperglycemic but, it’s not given IV bolus. Rather, always by an IV continuous drip. Not because we are cowards and don’t want to deal with the excitement of a sudden shift but rather because treating by IV bolus can be unpredictable and the drug would have a very, very short duration of action with that administration. IV insulin only has about three or four circulations through the filtering organs before it’s removed from the system. I think the half-life is something like 5 minutes. You may see measurements of glucose in the blood drop very, very quickly, but then rebound with any glucose still being absorbed. IV bolus insulin is a explosion and not a controlled burn. In the hospital we never give it IV bolus but rather by insulin drip, continuously delivered and titrated for effect.
I hear people saying they self-administer insulin as an IV bolus, carefully, and like the response. I’m not here to talk anyone out of doing so. But I thought it might be useful to hear why we wouldn’t do that in a clinical setting. I’ll also suggest that if you are going to treat a high blood sugar, at home, by IV injection, maybe have someone with you who could call for help or give glucagon if needed. It can work so fast and so well that you wouldn’t be able to save yourself.
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I suspect that the number of people who are actually giving IV injections is very small even out of our readership, and even smaller in the overall diabetic population.
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With the short needles I think ID would be nearly impossible if I recall correctly Nicky, you are using what I consider relatively small amounts. I am injecting 10 units or more. With that large of a volume, it’s much easier to see the characteristic medication bubble rising on top of the skin that ID creates.
In terms of how long it lasts, I have not had occasion to do it since I have been using a CGM, so my info is highly observational. Nonetheless, I can certainly share what I have observed for myself.
Humalog seems to last for about 8 hours for me. I see a slight spike at about 3 hours. It’s almost more like it turns Humalog into N for me.
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I’ve never had the ENDO recommend this. The nurse, the CDE, or OTHER people at the Endo office doing Rx’s yes. Like most Rx changes, the OTHERS gave me resistance and excuses, but ultimately when I said “if he won’t change the Rx, have him call me so we can discuss it,” no phone call, and Rx was changed.
Dirty little secret I maybe shouldn’t share, but I am going to anyway: insulin needles, the ones glued to syringes anyway, are typically well attached and thin enough to be easily bent. With this type of syringe, you can bend the needle to help achieve an ID or IV injection if all other means are failing. If you do this however, it’s very important to pay attention to where the needle and syringe meet to make sure insulin isn’t leaking out.
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I appreciate your sharing this information. I’m one of the few people around here (or at least that’s my guess) that does make use of IV insulin at home. I will have to keep that rebound in mind the next time I do so although I’d have to say that what I have noticed of it so far has not been outside of what insulin does through any kind of dosing when it’s outmatched by remaining absorbable glucose. I’m trying to use your words so I can sound like I know what I’m talking about, but what I mean is that even when I do a sub-q shot, no matter the size, I’ll only see that drop as long as I have it all covered. It’s not uncommon for me at all to see a dip and then a steady rise again. In fact, that used to concern me that something was wrong, but now I understand I just need to do more insulin. From my own experience (which is limited and flawed no doubt), IV acts just as the other forms as long as I’ve covered it adequately. Being that my diabetes is a prankster the way it is, sometimes I have, and sometimes I haven’t. It just does it much, much faster–as you’ve said, in as quickly as 5 minutes.
Just out of curiosity, have you ever happened to have used Afrezza? I ask because I now have two forms of insulin that are very fast to take effect. Interestingly enough though, Afrezza would be the one I would describe more as the explosion. It is loosely comparable to IV in speed, but its action is actually quite a bit different. It seems to start picking up momentum about 10 minutes in, really moving out within about 20 minutes, and, for me, seems to be all done as soon as 40-45 minutes after the dose. Because of that, I often do have to look out for the need for another bolus. I also do think Afrezza is an amazing drug and find myself thinking that the flaw in it has to do with the process–and the lack of being able to determine what you’ve gotten. In this regard, there’s some mystery… Did I get 4 units? 7? And I’m also completely unclear as to what the true conversion is. I’ve been told it’s 2:1 (Afrezza to injectable insulin), and yet I often find myself doing in Afrezza units exactly what I would do in an injection. It makes me wonder whether that “explosive” effect isn’t more a result of an incorrect dosage than it is the actual insulin. This, in my mind, could also be true for IV… and, really, any other kind of dose (though trailing in potency, of course).
I truly hope I haven’t come across as trying to talk anyone into it either. I genuinely appreciate your sharing your information. I was very leery in the beginning, but it’s one of my best, most reliable tools now. This doesn’t mean I don’t take it seriously and do it carelessly.
No, I also hope no one in this thread implied that either. I have an enormous amount of respect for the folks around here and how they handle their diabetes, and they’re doing things every way possible. I definitely don’t mean one strategy to be any more or less cowardly than another. In fact, I’ve never thought of any management style in those terms, so I do hope that wasn’t implied.
This certainly does sound scary, but I’d like to add my own experience to it as well. Yes, in the beginning, I made sure to be with someone and made sure they knew what I was doing. It was a very safe way to learn. I genuinely no longer need anyone around when I do my IV just like I don’t need anyone around when I do any insulin at all. I also don’t do big boluses, and I do believe that’s an important point. Again, I don’t want to sound like I’m encouraging it, but I also want to share my experience as it has been mostly very different from what you have described.
Have had some time to think about some of this… and am coming back to talk to myself about it. 
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I’m okay with talking to myself. I mean, on the rare occasion it happens. 
This is what I wanted to come back on. I wrote my response earlier, jumped in the car to get my son, and found myself thinking about the whole idea of the explosion—and my comparison of IV and afrezza experiences. In my response, I agreed with how quickly it took action, but I’m not sure I was clear that I absolutely agree it also is of short duration. Now I understand why you explained it the way you do, as being explosive, and, yes, I would agree in that context. I responded the way I did because I understand this about the way it works so I would never use it for something that needed a longer duration. It’s just one tool, and that’s the way I’ve learned to use all types (and methods) of my insulin–for each one’s specialty.
Now I’m tired and not sure I should be trying this at all right now but didn’t want to forget. I guess I wanted to say that yes, IV is more explosive and, for that very reason, is actually an excellent tool. I am able to use it as a single dose to cover a short-lived rise (like for coffee), but I rarely do. In general, I use it as a temporary bridge–to give my numbers some relief while I wait for my Novolog to take effect. So I might do an IV in conjunction (within a small window of time) with a regular bolus. A now and later. I also might do it when my blood sugar has just gotten away from me, and I don’t want to sit high when I know I don’t… have to.
I also realized the reason I described Afrezza as being more “explosive” than IV is that, as I’ve just started using Afrezza, I haven’t gotten comfortable enough to use it in that way–in conjunction. So I’m pretty much using it as a one off to fix whatever I need it to fix or to cover whatever I’ve consumed. It does burn out quickly and, as a result, there sometimes is a need for a repeat dose.
Again, I don’t want to come in and sound like I’m selling anything because I really am not. I said it earlier that I could not have done this a few years back. It would’ve been ugly–if not tragic. But where I am now between my knowledge, skill, emotional, and mental… statuses…
… it’s an amazing tool. I’m enjoying the thread and hope to take some of your knowledge into consideration as I wade through my diabetic days. 
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I’ve never used Afrezza but it seems to have a following. Heck, I’ve not even tried Fiasp. Mostly, I’m a Novolog via X2 gal.
When I use the term “rebound” I mean a blood glucose level that goes down with treatment but then comes back, quickly to the same level or only slightly lower. This can result from undigested food in the gut where glucose is absorbed or maybe the drop was so fast and hard that the liver dumped rescue glycogen which also has a very short duration of action. But realize not all glycogen reserves are equal. An athlete post-workout or someone in ketosis will not have the same reserves as, well, me. And if someone is drinking alcohol and injects IV insulin, well, the news could be very, very bad. I wonder if I made up some t-shirts saying, “Don’t Drink & Mainline Insulin” if they would sell? 
The body has an exquisite system of continuously dripping micro-doses of extremely short acting insulin and glycogen into the bloodstream. In that way it’s supplying checks and balances to keep blood glucose mostly level. Trying to replicate a healthy body’s response, with even our most advanced looping systems and fast acting insulins, is crude in comparison. Just be cautious out there is my bottom line.
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For most T1’s, the liver does not respond to low blood sugar. Generally after 5 years, the alpha cell’s glucagon response is gone, and the epinephrine response to hypoglycemia is also impaired.
Yes, of course! I totally agree with that
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