Rotating Insulin Injection Sites

Specialties Endocrine

Published

Specializes in LTC.

I just finished my ADN year of school this spring and when we were just ready to graduate I remember my instructor telling us that the ADA had announced that we should no longer rotate insulin injection sites daily rather weekly or monthly. I cannot find any thing about this online and would like to know if anyone else has heard of it. Thanks :uhoh21:

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yes, in Lewis & Heitkemper:

"rotating sites causes variability in insulin absorption, rotating of injection sites to different anatomic sites is no longer the recommended practice. Instead, clients are advised to rotate the injection within one particular site, such as the abdomen. Sometimes it is helpful to think of the entire abdomen as a checkerboard, with each square representing an injection site as the client rotates sites systematically across the board."

The diagram shows the abdomen sites with 4 rows and then 4 or 5 columns (so there are 14 sites on the right abdomen, and 14 sites on the left abdomen)

the arms have 2 columns and 4 rows on each arm (eight sites on each arm)

another 8 sites on each thigh

and 6 sites on each buttock

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Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.
yes, in Lewis & Heitkemper:

"rotating sites causes variability in insulin absorption, rotating of injection sites to different anatomic sites is no longer the recommended practice. Instead, clients are advised to rotate the injection within one particular site, such as the abdomen. Sometimes it is helpful to think of the entire abdomen as a checkerboard, with each square representing an injection site as the client rotates sites systematically across the board."

The diagram shows the abdomen sites with 4 rows and then 4 or 5 columns (so there are 14 sites on the right abdomen, and 14 sites on the left abdomen)

the arms have 2 columns and 4 rows on each arm (eight sites on each arm)

another 8 sites on each thigh

and 6 sites on each buttock

This is the method I've always used to teach site rotation--except I tell the pt to picture an imaginary circle (about 1.5 inches in diameter) and inject in this area for a week to 10 days for TID injections (the Novolog, Humalog, or Apidra) and for 3 weeks with Lantus, Levemir, or NPH. Then I tell them to move to the adjacent spot. By the time they get back to the initial injection site, the tissue has had plenty of time to recover and there is no lipodistrophy or hypertrophy.

I like the checkerboard idea though--it may be easier for the pt to picture and keep track of.

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