Jewels Doskicz is a registered nurse, freelance writer, patient advocate, health coach, and long-distance cyclist. Jewels is the moderator of Diabetic Connect’s weekly #DCDE Twitter chat, and she and her daughter both live healthfully with type 1 diabetes.

There’s one thing we all learn while juggling diabetes: there are no absolutes in diabetes management. With differences in daily routines, equipment mishaps, insulin absorption issues, and other wild cards, managing diabetes is a practice that’s far from black and white. Understanding the differences we experience with insulin absorption is a necessary part of the equation.

So how do we maximize our insulin absorption?

Injection site location

There’s a lot to think about when choosing where to inject or place a pump site. These issues are important for insulin absorption and, ultimately, blood sugar numbers:

  • Steer away from muscular areas. We know that structural changes in tissue affect insulin absorption, which is why scar tissue can slow insulin absorption greatly.

  • Keep a few inches from the belly button. Most people with diabetes are fond of using the abdomen if they have adequate fat to do so; there are less nerve endings found in belly fat, which results in less pain. It may seem tempting to inject in your most padded spots, but blood flow may be decreased with increasing layers of adipose (fat) tissue, possibly decreasing insulin absorption.

  • Rotate the sites and avoid the high-use areas that you may be drawn to time and again. Kids are big fans of reusing the same injection spots over and over again—it hurts less and they’ve created a habit. Kids (and some adults) also have limited real estate to work with.

Exercise

You may have been advised to avoid injections into arms or legs prior to exercise. If you’re about to go for a run or play soccer, would it be a questionable practice to inject into your leg? Research has shown surprising results, concluding that “insulin was absorbed faster from the abdomen than from the thigh under resting conditions and during exercise.”

Medical writer Kelly Close, who has type 1 diabetes, says that injecting insulin into your abdomen can be “sometimes almost twice as fast” as injecting into your arm or leg.

The trick is understanding how this will unfold for you. If you are aggressive with your sport, you may see rises in blood sugars regardless of where you inject. Be smart. If you exercise after injecting, test your blood sugar to see what the results are for you; adjust your practice to fit your needs.

Temperature

Your insulin may absorb more or less depending on how hot or cold it is. Diabetes Health tells us that “taking your insulin injection and then taking a hot shower, sauna, or going into a hot tub will increase the rate of absorption of insulin and may lead to an insulin reaction.” On the other hand, cold temperatures can lead your body to absorb less insulin, which could result in serious high blood sugars. To ensure the best absorption, avoid extreme temperatures at injection sites.

Leisure time

We all have down time—it’s a normal part of our existence. But hours spent in the same position with minimal movement can be a challenge with diabetes. The occasional experience of injecting insulin with minimal to no results can lead to dangerous over treating and low blood sugars. Getting up and moving your muscles will help your body respond better to insulin, according to the American Diabetes Association.

Movement increases insulin sensitivity both during and after the activity; many people experience low blood sugars with the simple act of exiting an airplane and walking to baggage claim.

Stitching it all together

Seek guidance from your healthcare provider about where, when, and in what settings to inject your insulin for the best absorption. Be certain that you understand the peaks and valleys of your blood sugar and how your body reacts to different types of insulin and different injection sites.

The most effective way to get the best insulin absorption is to keep detailed notes on your daily routine and blood sugars. Make adjustments in coordination with your healthcare provider based upon your results and their interpretation.

To learn more about insulin:

Insulin Pumps: Myth vs. Reality
How to Inject Insulin
New Inhalable Insulin: Afrezza