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If a sub-cutaneous injection is to be given, where is the least painful site?

Injection into the thigh muscle is suggested for some unknown reason, and the instructions advise simply to avoid muscle and veins. Concerning since I have no medical training!

The thigh seems like it would be painful, so I've been doing my shoulder/upper arm area since I used to lift a lot, I thought they'd be a good target, but all but one so far have been a bit more painful than I'd have expected.

So what "sub-cutaneous" injection sites would be least painful?

Butterfly and Bones
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Jodes
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    This might be a good fit for Health.SE. But in my experience, it's the anterolateral thigh. (insulin-dependant gestational diabetes.) – anongoodnurse Jul 10 '18 at 04:19
  • Excellent thanks - also flagged a request for Q to be moved – Jodes Jul 10 '18 at 17:29
  • The ones you already know about are the least painful. That's why they're recommended. Perhaps you're doing it wrong? If these are insulin injections the needle is tiny and shouldn't be painful. You just stick it in rapidly in one quick motion, inject, and then remove. It shouldn't be more painful than a skin prick. Voting to close as primarily opinion-based. – Carey Gregory Jul 11 '18 at 01:16
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    @CareyGregory - This is a decent question, and the answer(s) would be helpful to anyone who needs to self inject. Let it be. – anongoodnurse Jul 11 '18 at 02:30
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    @anongoodnurse How do you reconcile this question with the site guidelines? How does it end up being more than opinion? – Carey Gregory Jul 11 '18 at 04:01
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    @CareyGregory - There are millions of Insulin-dependent diabetics. Do you really think this hasn't been studied? – anongoodnurse Jul 11 '18 at 04:13
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    I advocate to leave this question open for now. While I can see that this looks like a POB question, there might be studies or guidelines for sub-cutaneous injections (haven't checked yet), so I feel like we should give this post some time. If there was nothing to find after all, we can close. – Narusan Jul 11 '18 at 12:21
  • As a diabetic for 40 years, I can only say that stomach and thigh are the only places I can easily reach with an insulin pen in order to press the plunger. For both places it helps avoid muscle, if you raise your skin with your other hand before pricking. Nevertheless in both areas you might occasionally strike - I presume a nerve - which will give you a burning pain for several seconds, or a blood vessel which will give a drop of blood. I have not noted any appreciable after effects of those. Also it helps to use a new needle for each injection - with pens people sometimes don't bother. – Gnudiff Nov 24 '18 at 07:17

1 Answers1

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If an injection seems especially painful or if blood or clear fluid is seen after withdrawing the needle, the patient should apply pressure for 5–8 s without rubbing. Blood glucose monitoring should be done more frequently on a day when this occurs. If the patient suspects that a significant portion of the insulin dose was not administered, blood glucose should be checked within a few hours of the injection. If bruising, soreness, welts, redness, or pain occur at the injection site, the patient’s injection technique should be reviewed by a physician or diabetes educator. Painful injections may be minimized by the following:

  • Injecting insulin at room temperature.

  • Making sure no air bubbles remain in the syringe before injection.

  • Waiting until topical alcohol (if used) has evaporated completely before injection.

  • Keeping muscles in the injection area relaxed, not tense, when injecting.

  • Penetrating the skin quickly.

  • Not changing direction of the needle during insertion or withdrawal.

  • Not reusing needles.

Insulin may be injected into the subcutaneous tissue of the upper arm and the anterior and lateral aspects of the thigh, buttocks, and abdomen (with the exception of a circle with a 2-inch radius around the navel). Intramuscular injection is not recommended for routine injections. Rotation of the injection site is important to prevent lipohypertrophy or lipoatrophy. Rotating within one area is recommended (e.g., rotating injections systematically within the abdomen) rather than rotating to a different area with each injection. This practice may decrease variability in absorption from day to day. Site selection should take into consideration the variable absorption between sites. The abdomen has the fastest rate of absorption, followed by the arms, thighs, and buttocks. Exercise increases the rate of absorption from injection sites, probably by increasing blood flow to the skin and perhaps also by local actions. Areas of lipohypertrophy usually show slower absorption. The rate of absorption also differs between subcutaneous and intramuscular sites. The latter is faster and, although not recommended for routine use, can be given under other circumstances (e.g., diabetic ketoacidosis or dehydration).

American Diabetes Association Diabetes Care. Insulin Administration. 2002 Jan; 25(suppl 1): s112-s115.

Apart from this, I can only tell you that I've been predominantly taught to do subcutaneous injections with either insulin or heparin in the abdomen, though with no particular reasoning.

Narusan
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  • Re the abdomen, what I was told was it has few significantly sized surface veins and a relatively even layer of fatty tissue so it is unlikely the substance will enter either a vein, organ or muscle accidentally. – Vality Aug 27 '19 at 19:33