Diabetes type 1 (young people)
Insulin: doing injections everyday
The young people we talked to tell us what it is like to inject insulin every day, the problems they've had and how they've coped with them.
Where and how to inject
Young people are taught by specialist diabetes nurses and doctors how and where to inject. Arms, legs and the stomach are all parts of the body recommended for injection. Most people said that their preferred place was the stomach. But they also said that it's important to vary the place where they inject, over a wide area. They said that injecting in the same place can cause lumps or other changes, called hyperlipotrophy, to develop under the skin. Your healthcare team can teach you how to recognise these changes. Injecting into the areas that have developed this problem is usually completely painless but the insulin may then be absorbed unevenly, which makes blood sugar much harder to control.
Some young people who were small children when diagnosed said that they have grown up with doing daily injections and thought it was normal. Other children were scared of needles at first and their parents had to inject them, to begin with.
He started doing his injections twice a day when he was eight years old. Doing his insulin injections hasn't been a problem for him.
He started doing his injections twice a day when he was eight years old. Doing his insulin injections hasn't been a problem for him.
Well, I mean, I started doing my injections like when I was about eight, I suppose, eight or nine, but, I mean, obviously I kind of just did it, people left me to it. Well, yeah, you just get on with it, I suppose
Were you still at school when you started doing the four injections a day?
No, I'd left, had I left? [pause] No, yeah, no, I must have, I'd left, I wasn't doing four injections then at school. I never brought, I never brought my insulin into school.
Okay.
So it might, yeah, it might not been that long ago. I suppose, what'
So you left school at sixteen?
No, I went to sixth form as well, but I can't remember - no, maybe I didn't, maybe I didn't start until I was eighteen, then, I suppose, doing the four injections a day.
You had a fixed regime until you were eighteen?
Then I moved to four injections a day.
How did you find it, I mean?
When they tell you are going to have four injections a day you think oh, God, you know, this is really bad I'd better stay on two, but then when you do it, it's much better. I mean you can't, I couldn't live on two injections a day without eating a certain amount and eating at certain times, you know, you just can't do it, so. Four injections a day is just better because, you know, you can eat when you want, what you want.
So was it difficult when you were a teenager to have these two injections a day, this very fixed regime?
Well, not really, because I was quite sporty, I mean, when you are at school everything is, you know, time slotted anyway so it was easy at school, you just eat at lunch and you eat, you eat, eat at morning and you eat at tea, so it's not an issue, you know. You just get on with it. I mean, at the end of the day I'm glad I got it when I was seven instead, and not when I was eighteen, if I'm honest. I'd much rather, at least I knew I had it and I was used to it by then instead of getting it when you're eighteen and when, you know, you're trying to have a laugh, I think that would be worse.
So, injecting for you wasn't a big issue?
Not really. It wasn't, you know, my mates knew I did it. But now I don't have a car, I do it whenever I'm in a restaurant, I do it at the table. I refuse to go to every, I refuse to have to be banished to the toilet in a restaurant, I was, it annoys me when people ask me to go, I don't. I do it, I don't obviously stand up and make a big scene, but I do it at the table in my arm. I refuse to, I don't see why I to have to go and visit every toilet in every restaurant that I ever go to, especially when most of them are really nasty. So, I do it at the table.
He hated doing the injections at first, but with help and encouragement from his family, friends and medical staff he's overcome his fears.
He hated doing the injections at first, but with help and encouragement from his family, friends and medical staff he's overcome his fears.
Was it easy to start injecting yourself?
I absolutely hated injections. I detest them. Going to the clinic to have blood taken I absolutely hated it and it was really like nerve-racking, thinking about, 'Oh I've got to inject myself. I got to put a needle inside me', stuff like that. But to be honest it becomes a daily routine. And I think you do, that's one of the things that you do tend to get used to. As long as you follow the nurses instructions and they tell you exactly where to do the injections, how to do them and as long as you follow that it should be relatively painless because it is for me now.
In which parts of the body do you inject?
There are several places actually. In my stomach, you've got like a little arch round your belly button apparently where you can inject. It's sort of painless. Top of your leg, you can also inject in the top of your arm but I haven't got enough fat or flab there to inject [laugh]. And one of my mum's favourite actually was in the top of your bum but I stopped her from doing that because she enjoyed it too much [laugh]. She enjoyed giving me a little bit of pain in the evening times [laugh].
So she to start with, she helped you?
To start with my mum injected me a lot because I didn't feel comfortable doing it. I mean, and I do thank you, thank her for that but everyone needs to get on their own sometime and do it themselves so.
So for you it was sort of that kind of a slow process of your mum helping you and doing it and then sort of you taking over slowly?
Yeah it was a, it was quite a quite a slow process. I mean it's not, it's, to be honest with you it's not an easy thing to get used to. You have to take it one step at a time. You could, you can't jump ahead and think, 'Oh yeah I'm, I can do this' and all. You have to take on everything that everybody says and everybody trying to help you. You have to take it all on board because if you don't [sigh] well you're screwed basically. You could just can't do it by yourself. You need a lot of help from your family. Even my friends helped me. I mean as soon as they found out they asked about what they can do to help me when there's problems. How they can notice it when there's a problem wrong with me. I mean some of them [laugh] even wanted to inject me but [laugh] I think that's for their own pleasure though [laugh].
He says you won't get used to doing injections in a day but, with practice, you'll learn the best way of doing them for you.
He says you won't get used to doing injections in a day but, with practice, you'll learn the best way of doing them for you.
How long it took you to get used to injecting yourself?
It didn't take me long. It took me maybe a few weeks, maybe a month. I'd have my mum would help me in the mornings. She'd help me just injecting my leg because just the concept of putting a needle into my leg was a bit, it took me a while just to put it in and she helped me with that. But after a while I realised I'd have to learn to do it myself and I did. And the, the simple thing is, if I just kind of keep changing the needles it really doesn't hurt at all. It only hurts if you don't change the needles.
But the, but I got into it quite easily. I think I'm just an exception. Because I know quite a lot of my friends are really squeamish about needles, when it comes to vaccinations [background noise] they get all jumpy and I'm like, 'Oh, it's fine, you know, it's just a, an injection in your arm, it's nothing' So I get used to it, and it's no problem at all now.
If my mum was busy or anything she'd say, 'You're going to have to do it yourself this time.' And I did. And you know, every time I'd do it I always like to think of ways to make it easier and quicker and you know, and, over the years, you know, I've found a way to do it quickly. And you know, pinching just pinching the skin and inserting it slowly and you know, just slowly injecting it and then leaving it in for a few seconds for the insulin to absorb and I don't know, it's just practice, really, practice makes perfect. And this experience over the years, you, you can't just automatically find the best way to do it, it takes a lot of times. But, you know, I do it often so I get used to it and find the best way to it really quickly.
At the age of 11 he decided to start doing his own injections because his parents couldn't tell which areas would hurt him.
At the age of 11 he decided to start doing his own injections because his parents couldn't tell which areas would hurt him.
How old were you?
I was about eleven I think, maybe younger because I used to do it in my bum, well my parents did. And my mum did because my dad was useless with needles and stuff like that. He was' he did try his best and he always tried to understand it. And he was usually the one that did come in from work to check-up on me but if you do it in the same place over and over again there, it becomes swollen and it's not as good at absorbing the insulin as it could be if you keep doing it in different places and the problem is if you do it yourself you can feel where the best places to put it because you know it will hurt if you put it into a place that you've been using over and over again. My mum didn't know that and so it [started to] really hurt sometimes. So I thought enough of this, I'm going to learn how to do it for myself. And so one day I did. And my mum was, very proud of me and she took a load of photographs so I've got some of those as well. And I was very proud of myself because it's all part, part of growing up I guess.
Yeah, I think I didn't always do it myself. I think it was kind of a transitional, you know, my mum would do it sometimes and then when I felt brave enough I'd do it and I'd do it in my leg. But I have an uncle who's diabetic as well and he does it in his stomach and I always used to be, really disgusted by that. I used to think, oh how can you do it in your stomach. But now I've been doing it in my stomach for a very long time because my legs used to bruise very easily so it's better to do it in my stomach, well I find. I mean some people do it in the, their arms and I still can't understand how they do that. It must be really painful.
It could take a long time to get used to injecting every day. One young woman diagnosed two years ago still has some difficulty when it comes to doing her injections. The diabetes nurse recommended a device called PenMate where she presses a trigger which shoots the needle into the skin. One young woman remembered that her mother or grandmother used to give her one out of the two daily injections when she was still asleep. She was in her teens before she started doing her own injections.
It was after leaving school when she really started doing her own injections.
It was after leaving school when she really started doing her own injections.
Yes, very. It was like first, it got really difficult getting used to having them. It's like my nan or my mum would give me my injection and literally I would run out of the living room and shut the door and I'd pull all the cushions off the sofa, throw them about, anything that I cold get my hands on. If my nan was in there or my mum's giving me my injection, so I'd hit them, kick, scream, you name it, I did it. And that, so, I, it was just getting used to because that's, so everyone around me being fine and that, I was, I did have the injections I found that quite difficult. But as I got older it got easier It became more a part of life and that But at the beginning I did find it very difficult and they, it was like my nan found it difficult giving me injections, like they would have to hold me down half of the time to give them else I would just, I wouldn't have had them otherwise. So that was difficult.
And when did you learn to inject yourself?
It's like they did it until I was up to about 13 or 14 really because it was just something, I found it very difficult, I only liked having injections in my arms by that stage. I didn't like my legs or anywhere else, and I find it difficult to control the injections by doing it in my arm and that. So my mum and nan used to still do it for me up to about the age of 14. It's like my morning one, they used to do while I was still asleep, so then it was like I was only having one injection a day because I wouldn't know I've had that one in the morning, because I'd have been asleep.
It's like last, they used to give me the odd one, it's been the last couple of years that I've really, that I've left school and that I've really taken charge of giving my own injections. And really like, they don't do it at all now. It's like the only person that I allow to give it is my boyfriend, once every now and then. But apart from that, yeah, it's about 14 when I started doing my own.
She uses a device called PenMate to help her do her injections.
She uses a device called PenMate to help her do her injections.
Have you told your doctor about it?
Yes. I mean they were saying it shouldn't, it shouldn't hurt. And I might, I might go back and talk to them about it again. Because sometimes it's fine. But like this morning for example, you know, I don't know if I just, you know, hit a capillary or something, but it's just a bit sore.
So you always do it in the stomach?
Yes.
Yes. And I've tried in my legs a couple of times, but I don't know, I don't know if it's part of like my fear of needles, I just kind of think, 'Oh, but it might, you know, I don't know, might hurt'. Whereas here I've got, you know, enough fat to, you know, like as a cushion really. But it's funny, before I was diagnosed I had no idea about diabetes. I thought that diabetics injected in, like in their arms, like in a vein. I didn't realise it was just under your skin. So I was a bit relieved when I found, found out that.
And this thing that you attach to your pen and you just press the button. Where, who suggested that to you?
Well, I asked about it. I'd, I think I'd heard that there was some, this kind of thing. No, oh, no, actually, sorry, it was that the nurse had mentioned before I went on it in the first place, saying that they, there was that, but she'd rather, you know, I tried myself first. So I did.
And what's the name of this?
I can't remember. It's called like an autopen. Or, no, PenMate, that's it. And it just slips over the, the top of it.
And are you still kind of afraid of injections or how are you coping with it?
It's okay, it's okay now. I think before I just, I couldn't bring myself to do it. Well, obviously I did, but I'd just kind of sit there for ages sometimes just kind of, and I know you're meant to do it really fast, and I just couldn't. And I'd just do it really really slowly. Which of course made it kind of hurt a bit more sometimes and just made the whole process longer, rather than just doing it. So now I don't really think about it.
She found it very hard to take over from her parents who had been controlling her diabetes since she was four years old.
She found it very hard to take over from her parents who had been controlling her diabetes since she was four years old.
When I was about thirteen, fourteen onwards, they advised me that I had to try and do my injections myself, but it was really difficult, because after my mum and dad doing it for me all them times - all the years.
For how long?
From the age of four to fifteen, sixteen, so it was really hard to try and take on the role, and doing it myself and be more independent, because I was just relying on them at the time, which weren't really a good thing. So the doctor - the doctors kept advising me to try and do them myself, but it sort of weren't working until I was about sixteen. I went up to the adult clinic and it suddenly changed, my whole life really changed from then, really. The doctor was diabetic himself, and he said to him, and I said to him I was scared because I couldn't do my own injections and I wanted to go out with friends, and sleep over, but it was really difficult because my mum or my dad had to come round at a certain time and give me my injection, and it was just - it was just difficult.
She asked for help because she wanted to control her diabetes and be a normal teenager.
She asked for help because she wanted to control her diabetes and be a normal teenager.
Like what?
Just stuff to help my confidence to begin with, such as going out somewhere different. Just - it was just a gradual build up, but the thing that I liked was she didn't concentrate straight on my diabetes to begin with. It was more me as a person, so she was giving me tasks like to come home, and change my routine a bit, do something different, just things that you wouldn't thought would help, but it really did.
So I got given a few tasks like that. I had to write a diary of what went on in my life, school and stuff like that. I had about six sessions with just aims and objections that I had to do. But then it eventually got to the bit that I didn't want it to get to, which was the injecting, and she give me an orange to begin with to inject, and I injected it, but - that was fine - I could - because I could do my own blood sugars and stuff, so I'd done that okay, and then she give me her arm to try and inject, and it really got me upset because I didn't - because it - because I had such a fear of trying to inject that it eventually overcame me. I couldn't really - shaking, sweaty palms, panic attacks. So I was really pleased because after about ten minutes of just holding the injection in my hand I managed to inject her and that was the main point where I knew I could probably go further.
She tells us what she had to do to be able to conquer her fears and start injecting herself.
She tells us what she had to do to be able to conquer her fears and start injecting herself.
Yeah, that was my first experience injecting. I didn't inject her one time, I injected her about six times, so that was really nice of her to let me do that. And I was on a high from that really, like a buzz, because I knew that I could eventually, like, do it, so I thought maybe I could do it myself. So I went away and I had to write down my thoughts and feelings, and she said I had to try and inject my dad, and my mum, like for two weeks and then I had to go back and see her, so I was a bit scared of doing it because I didn't want to hurt them and I - and I wanted to do it for myself, so they were good enough to let me inject them, after dinner. Because they were taking on my role really - I had to inject them after dinner, when I would normally have to be injected, and in the morning. So, I injected them for two weeks. Some days I had blips I couldn't do it, so I just left it, because I thought I can't really push myself if I know I can't do it, because it just got me really angry, so I left it for a while, and then I done it and I went back and told her what happened and stuff, and she was really pleased with me.
And then the bit I didn't want to know got to - you got to do your own injections, like yourself, now. We've got to build you up to eventually doing it. So she asked - she give me an injection, filled with like saline solution, just like water, and she said after, like a few sessions, she said, 'You've got to do it yourself now'. In a round about way. She didn't directly say it like that, but she had to try and coax me into doing it. And I knew that the day had come that I had to do it, because that was what happened. So I got given the injection and I had to think positive thoughts, like, 'I've got to do it, it'll help me, I'll be able to lead my own independent life, be like everyone else', so the more positive thoughts I got the more - it sort of pushed me, and I felt - and it sort of pushed me to do it, so I got the injection in my hand, and eventually it went in my leg. I had to hold it there for five seconds, and pull it back out and that was the biggest achievement for me by far, and I had to do it again. I had to do it about five more times, just to make sure that I'd done it right. Then I went home from there on a real high, because I could do it and stuff, and then the time come, like, after dinner I got given the injection and, and for some reason I could just do it. It was just after the whole year and a half of going there that I just managed to be able to find the strength from somewhere for me to just do it. Because it weren't just like a normal fear. It was just like a block, because my parents were doing it for the past fourteen, fifteen years, and I just got accustomed to it, so from then on I've been doing it every day.
I think the counselling and the help of the adult clinic, that was the main thing that helped me do my - and just the - the coaxing along and just encouraging from friends, family and everything and that - that was the main turning point for me.
The young people we talked to said that there have been instances when they have forgotten to do their insulin injections. They said that it is not always easy to remember to do them. Reasons included: being in a hurry to go out with friends, being too tired to remember, finding it difficult to do them at school break time, not wanting to carry the kit with them, having been ill, etc. Some young people said that they need a lot of reminding and that their mothers do most of the 'nagging'.
Says that his mother 'nagged' him and that he now has a routine to make sure he doesn't forget his injection.
Says that his mother 'nagged' him and that he now has a routine to make sure he doesn't forget his injection.
Supposed to do them every day, twice a day. Before, before about a year ago I used to be forgetting it all the time. Not, doing one injection, forgetting to do the next one.
Why do you think you were forgetting?
It's just the whole change of lifestyle [sniff]. When you become a diabetic you change from being able to go out with your mates to wherever you want, to having a set routine. Like I said before you have a set routine. And you have your tea. You come home. Have your tea and think' Oh I'd just rush around and do this and then I'd just rush around and do something else and I'll go out with my mates and by the time you've got out with your mates, you're all hot and flustered and you can, 'God I'm high. I've got loads of sugar inside of me. Damn I forgot to do my injection'.
And it's really stupid to do because a few months ago now I got salmonella poisoning which I could have died from. I was in hospital for about a week. I could have, I could have died. And that was quite nerve-racking. But maybe I wouldn't have got it as much if I'd had a more controlled count. If I'd have been taking more care of myself, so to speak. Because you are a hell of a lot more prone to getting diseases like that.
What helped you to, now to remember to do your injections?
Back to the nagging thing again, my mum. She whenever I have something to eat they always say. '[Name] I didn't see you do your injection'. I'm thinking, 'Yeah I know I didn't but damn'. Do you know what I mean? It's, it. They remind you and it's also. It becomes a daily routine. When I come in of an evening time I come in and close the gate straight away. When I come in and have my tea I come in and do my injection straight away. It becomes a part of your lifestyle. You just remember to do it automatically in the end. Takes a while but you do remember.
So you do your injections before your meal?
You do them before or after but I would advise you do it before because with me I usually end up. If I forget so I do it after my tea but by that time I've already got a full stomach of food and it's quite painful. It can be quite painful to do it in your stomach after that. So I would advise you do it before you, before your meals.
And that has worked for you?
That works for me, yeah. It's doing it before my meals it's my routine.
How do you respond when they nag you?
[sigh] Truthfully I do get agitated and quite angry with them and I do have a lot of arguments about, with them about it. But I get angry with them probably because of me not doing something right. And it makes me feel like an idiot basically. Letting them tell me that I'm not doing something right and because when I first got diabetes it felt like. It felt to me like I'm the one that's got it not you. Leave me alone to do it, sort of thing but you'll learn they're there to help. They, they're going to help you whether you like [laugh] it or not sort of thing. And basically just take it on board.
He kept forgetting to do his lunchtime insulin injection at school because he wanted to be with his friends.
He kept forgetting to do his lunchtime insulin injection at school because he wanted to be with his friends.
How are you finding the regime?
Now? It, it's working out fine. It's better than it was before. It still requires me to push myself to take the injections when it's required. The problem is, now, at school, is when, when I come back from lessons I usually come back with my friends and we used to go straight to the cafeteria and I have, I know I have to go off and take my injection while my friends go off to take their meals and there's a line in the meals and if I go off I'll be separated from my friends and I'd have to hope that they, you know, not eat their lunch as quickly so I can stay with them and eat. And on occasions I might feel, you know, I really don't want to miss out sitting with my friends, we're talking about something really interesting. So I would, I would not take my insulin and I think I'd just take it afterwards. And afterwards I'd want to go with my friends to sit in the lounge and watch TV or talk something and I really wasn't in the mood to go off take my injection. And I'd end up missing my injection for my lunch which meant that I felt high blood sugar throughout the afternoon which really wasn't nice throughout the lessons and I really didn't want to go out the lessons to take my injection and I really was underestimating the importance of taking insulin because I at that time of having high blood sugar makes you feel tired and lethargic and in a state of mind which is really negative. And it's not a good state of mind to tell yourself to be, to asked to be excused from the class and to go off to do injection and so on. And that was dangerous.
Are there any other reasons why sometimes you forget to take your insulin?
It might be on the rare occasion that I'd forget to take my injection with me, which is very rare, it happened to me a few times. But no there isn't really any other reason apart from the continuous, you know, movement with friends, just going along with the group, being part of the group of friends. You don't want to just seclude yourself so, just to take some insulin because once you do they're off, they continue off to take, to have their lunch and I'd have to just I'd be a few metres behind because I'd had, I had to take my insulin. And that's the reason. I didn't want to be left behind, I wanted to stay in the group, have lunch with them at the table and talk with them and then go off with them for the, for the free time we had. Whereas if I'd taken my insulin I'd have to eat quickly just to stay with them. And either that or find other people to sit with to eat. Which wasn't really bad but I really wanted to be with my friends for the time.
If we go back to the insulin taking at lunchtime when you were at school, what do you think it would help?
If I think if what, what really helps is once, if I do take my injection on time, every, before lunchtime I think I've realised that it's really not that much effort that I'm just exaggerating the need and I think I should realise, I'm realising that it's more important to take control of my sugar than to than just to have that moment where I'm with my friends. Because my, I know my friends, they won't reject me just because I'm, I have to take my injection and I think the benefit of feeling good inside of having controlled blood sugar is, overtakes that of having the feeling of talking with friends at lunchtime.
One young man who has had Type 1 diabetes since childhood started to miss injections when he became older because he found the routine too boring and that it restricted his social life.
Doing an injection in public places
Young people have different attitudes when it comes to do insulin injections in public places. Most young people told us that they have no problem about doing them in restaurants, school/university canteen, etc. Other young people find it difficult to do it in public places and prefer to go to the toilet or another private place when they are out and about.
Last reviewed December 2017.
Last updated November 2014.
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