Insulin therapy is a life-saving treatment for insulin-dependent diabetic patients. But unfortunately, the only way to take insulin is via subcutaneous injections.
So, what if you fear needles? What if you just can't get used to injections and feel pain and discomfort every time you take your medicine?
Here are 10 tips for injecting insulin without pain!
Related article: Does insulin need to be refrigerated, and how to store it properly?
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Why do Insulin Injections Hurt Sometimes?
When insulin is administered through subcutaneous injections (as opposed to insulin pump therapy), the patient must use an insulin syringe or an injectable pen. Both imply inserting a needle through the skin to inject the insulin into the fat tissues.
Insulin delivery devices have considerably improved in recent years. A few years (or decades) back, insulin syringes were quite intimidating, but today’s needles are much smaller and thinner than they used to be. The needle tips' design has also greatly improved and is now much sharper, requiring less penetration force.
However, while these improvements make insulin injections as painless as possible, some people still experience pain and discomfort when injecting insulin.
Most people that find insulin injections painful report a burning sensation during or immediately after the injection. But why does insulin sometimes burn when injected? There are two main explanations:
- PH difference: Long-acting insulins like Lantus and Basaglar have a high acidity level that's different from the skin's pH level. This pH level difference can explain a brief burning sensation immediately after the injection.
- Temperature difference: Injecting cold insulin recently taken out from the refrigerator can also cause a burning sensation during the injection.
Redness and itchiness at the injection site
Common discomforts that may occur when injecting insulin are redness or itchiness at the injection site. But, most of the time, they're mild and are no cause for concern.
Such local injection site reactions may occur when you've hit muscle tissue instead of body fat, injected into a more sensitive area, or used the same injection spot too often.
Intense itching, rash, or hives could also be the symptoms of an insulin allergy or hypersensitivity. But insulin allergy is very rare, with an estimated incidence of less than 3% in diabetic patients treated with insulin.
Lipoatrophy and lipohypertrophy
Lipoatrophy and lipohypertrophy are the two main skin problems that can occur at insulin injection sites.
Lipoatrophy is the localized loss of fat tissue under the skin. Lipohypertrophy is the overgrowth of fat cells that makes the skin look lumpy or swollen.
Both lipoatrophy and lipohypertrophy can cause pain or numbness at injection sites. Ask your healthcare provider to check your skin periodically.
With a few simple good habits, you can avoid most of these discomforts and skin problems caused by insulin injections.
How to Inject Insulin Without Pain?
If you experience pain and discomfort while injecting insulin with a pen or a syringe, here are a few tips and good practices that may help. But, of course, it's a case of trial and error and personal preferences, so we hope you find the tips that best work for you.
Related article: A step-by-step guide to using an insulin pen for injections
1. Choose the right insulin needle size
There are different types of insulin syringes and disposable insulin pen needles. While some diabetic patients sometimes need longer needles, most are fine with short and thin ones (4 mm).
The thinner and shorter the needle, the less painful the injection. If you feel needle size causes the pain, ask your doctor to prescribe shorter ones.
Related article: How to mix two insulins into the same syringe?
2. Always use a new needle to avoid pain
Needles for syringes and insulin pens are disposable and for single use only. You must use a new one for each injection.
Old needles become dull, with a distorted tip that can considerably increase the painwhen inserted into the skin or pulled out. In addition, the fine tip risks breaking off in your skin.
Additionally, reusing insulin needles increases the risks of bacterial contamination and lipohypertrophy.
3. Gently massage before insulin injection
Some patients report that gently massaging the injection site a few minutes before the injection reduces the pain and discomfort.
However, while it helps soothe pain, massaging the site after the injection is controversial among experts. While some argue that it enhances insulin absorption, others say it could affect the insulin’s onset time and peak time of effects.
4. Choose your injection site carefully
Common sites for injecting insulin include the belly, abdomen, upper arm, thigh, lower back, hips, or buttocks. Most people find the belly to be the least painful.
Remember that insulin should be injected into fat tissues. Hitting a muscle, blood vessel, or nerve can cause pain during and after the injection. Never inject near joints, wounds, scars, etc. Some patients who are extremely sensitive when injecting insulin also report that injecting in hair follicles is more painful.
5. Rotating injection sites reduces the risk of pain
Your doctor and diabetes nurse have probably advised you to rotate the insulin injection sites. There are several reasons for it:
- First, injecting into the same spot too often can cause painful injections.
- Second, it causes a build-up of fat tissue (lipohypertrophy) that can become painful or numb.
- Third, it may impair your body's ability to absorb insulin in the long run.
So, while you probably have a favorite injection spot that is less painful or more convenient than others, it's essential you let it rest!
6. Injecting cold insulin is more painful
Injecting cold insulin is more painful than insulin at room temperature. So, while you must keep your stocks of insulin refrigerated, let your new pens, vials, or cartridges of insulin reach room temperature before you use them for the first time.
Reminder: Insulin is a temperature-sensitive drug that quickly deteriorates when out of the fridge or exposed to high temperatures. Insulin that’s been left out of the fridge or used for the first time must be used within a about a month.
Related article: Does insulin expire? How long is it good for?
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7. Shoot insulin without pain
To avoid pain while injecting insulin, grab a big chunk of skin and fat with one hand. With your other hand, hold the insulin syringe or pen like you would hold a dart, and insert the needle quickly with a 90-degree angle. Children or thin adults without much fat under the skin may need to inject at a 45-degree angle.
The quickest and more precise the penetration, the less pain. The key to minimizing the pain is speed and decisive motions.
Once the needle is fully inserted into your skin, push the injection button (insulin pen) or the plunger (insulin syringe) all the way in. Wait for a few seconds without moving to ensure all the insulin is delivered. Then, promptly pull the needle out without wiggling it.
Related article: Why and how to prime your insulin pen?
8. Make sure your skin is dry
Injecting insulin into dry skin helps decrease the pain or discomfort sensations. Wet skin is harder to penetrate with a needle.
So, always make sure the skin is dry at the injection site. If you use alcohol wipes to prepare and clean the skin before the shot, allow your skin to air dry before proceeding to the injection. This can help reduce the stinging sensation.
9. Relaxing helps reduce injection pain
If you’re nervous about insulin injection, your muscles will tense up, ultimately increasing the pain. So, while easier said than done, try to relax before the injection.
Sitting rather than standing may help relax the muscles. Inhale and exhale slowly. Maybe talk to someone else or listen to some relaxing music while injecting.
10. Try injection pain-reducing tools
Most people with diabetes are fine with insulin injections and end up finding a way to perfect their habits so that they feel no pain or discomfort. However, if you still find injections painful after trying all the above tips, you may want to consider injection aid tools. Here are some examples:
- Buzzy (seen on Shark Tank). It’s a handheld device that looks like a bug and sends high-frequency vibrations to numb the injection site before an insulin shot. It reduces injection pain from 50 to 80% and easily fits in a purse or pocket.
- I-Port Advanced by Medtronic is an easy-to-apply adhesive port that can be worn for up to three consecutive days. A flexible cannula is inserted into the skin and allows to receive insulin from a syringe or a pen without having to make an injection every time.
- ShotBlocker by Bionix is an affordable solution to reduce injection pain. It's a simple plastic disk with points that you push against the skin to saturate the sensory nerves, so the injection site is numbed.
- Insulfon by Intrapump is a soft cannula that's gently inserted subcutaneously to receive injections from needles and syringes without pain. It's been specially designed to help diabetic children overcome their fear of needles.
- Ice packs are another efficient and affordable solution to reduce pain caused by insulin injections. Apply an ice pack for a few minutes on the injection site before injection. Ice cold numbs the area, so the needle insertion is less painful.
Related article: A beginner’s guide to basal and bolus insulin
What about you? Do you find insulin injections to be painful? What best works to reduce pain and discomfort?
 Richardson T, Kerr D. Skin-related complications of insulin therapy: epidemiology and emerging management strategies. Am J Clin Dermatol. 2003;4(10):661-7. doi: 10.2165/00128071-200304100-00001. PMID: 14507228. https://pubmed.ncbi.nlm.nih.gov/14507228/
 Linde B, Philip A. Massage-enhanced insulin absorption--increased distribution or dissociation of insulin? Diabetes Res. 1989 Aug;11(4):191-4. PMID: 2696618. https://pubmed.ncbi.nlm.nih.gov/2696618/