Common Insulin Injection Challenges


Bleeding at the Injection Site

It's normal for a small amount of blood to occasionally appear when you inject insulin. This bleeding, which is usually caused when the syringe punctures a tiny blood vessel, can be stopped by putting pressure on the injection site with your finger or a cotton ball.

Also, be sure that you:

  • Don't rub the spot.
  • Maintain light pressure with your finger to prevent bruising.
  • If a bruise does appear, don't use that injection site again until the bruise is gone.

How to Inject Insulin

It's normal for a small amount
of blood to appear when you
inject insulin. This bleeding is
usually caused when the
syringe punctures a tiny
blood vessel.

If you frequently bleed when you inject, you're probably injecting incorrectly, or you may have a medical problem. Consult your healthcare professional if you find that you're bleeding frequently.

Getting a Comfortable Injection

Most insulin injections don't hurt. However, if you frequently experience pain while injecting, try the following:

  • Check with your healthcare professional to make sure that your injection technique is correct and you are using the correct sites.
  • Wait until the alcohol from the swab has dried completely on your skin before injecting.
  • Be sure you're not bending the needle when you remove the cap. Needle caps should be removed by first twisting and then pulling them straight off.
  • Inject your insulin when it's at room temperature. Cold insulin hurts.
  • Keep the muscles in the injection area relaxed during injection.
  • Never use your needles more than once. Reusing a needle can bend or dull the tip, which will increase the pain, and could cause it to break off and become lodged in your skin.
  • Larger insulin doses hurt more than injections of small amounts. To minimize injection pain, ask your doctor if you can split the dose.
  • Penetrate your skin quickly.
  • Avoid injecting into muscle by using a shorter needle, such as a 4mm pen needle. If you are using a 6mm or longer needle, pinch up the skin and inject into the fold of the pinched up skin.
  • Speak with your doctor about using a different needle size or injection device.
  • Speak with your doctor about injecting into other parts of your body.
  • Only use BD needles and syringes to inject your insulin. The fine diameters, sharp points, and lubricated coatings of BD's high-quality needles and syringes make your injections as comfortable and pain-free as they can be. (If BD products aren't covered by your insurance, contact us to let us know.)

Insulin Dripping from Pen Needle after Injection, or Insulin Leakage at Injection Site

If insulin leaks from the pen or from your skin after you remove the needle from the injection site, you may not be leaving the needle under the skin long enough. It is a good practice to count slowly to 10 before withdrawing the needle. Even after counting to 10, you might still see a very small acount of leakage at times. Research has shown that there may be a very small amount of leakage after withdrawing a needle. However, the amount is minimal and does not appear to affect blood sugar control.*

You may also not be pinching up the skin correctly. Make sure that you release the pinch before you remove the needle from the skin.

Also, never carry a pen with the needle attached - this causes air to enter the cartridge, slowing the time it will take for you to get your insulin dose.

Read about insulin pen precautions >

Clogging of the Insulin Pen

If your insulin pen is clogged or it's hard to press the button or plunger down, it could be due to the following: 

  • Small amounts of insulin are caught in the needle from a previous use.
    Solution: Change the needle for each injection, and do not reuse needles in the future.
  • There's a clump in the insulin.
    Solution: Be sure to properly mix your insulin before drawing it up if you use cloudy insulin.
  • You drew cloudy insulin into your syringe far before the time you were ready to inject it and some of it dried inside the needle.
    Solution: Fill your syringe closer to the time of your injection.
  • The dose you dialed may be more than the amount of medication remaining in the pen.
    Solution: Start a new insulin pen.

Skin Problems at Injection Sites

Skin irregularities can sometimes occur at injection sites due to changes in the subcutaneous fat, of which there are three types.

Fat hypertrophy (also known as "lipohypertrophy" or "insulin hypertrophy") appears as soft, often "grape-like" lumps under the skin at the injection sites. This unusual condition may be caused in some people by the natural effects of insulin (one of which is to cause fat to grow) or by reuse of needles. To prevent the further development of hypertrophy, rotate injection sites and don't reuse needles.

Fat atrophy (also known as "lipoatrophy") is a loss of fat under the skin's surface. This rare condition appears as a dip in the skin and has a firm texture. It occurs much more commonly with impure insulins.

Scarring of the fat (also known as "lipodystrophy") is caused when you inject too many times into the same site or when you reuse a needle. To prevent lipodystrophy:

  • Rotate your injection sites
  • Rotate where you inject within your injection sites
  • Rotate the sides (right, left) of your body where you inject within your injection sites
  • Always using a new syringe or pen needle with each injection

Some people find that it's less painful to inject into their lumps (often referred to as "lipos") than it does to inject into healthy tissue. Even though it's tempting, you should never inject into lipos because insulin doesn't absorb well there.

Lipos are often easier to feel than to see, so check your injection sites with your fingers frequently. If any unusual growths, textures, bumps, or indentations have formed, switch to another site and let your healthcare professional know about them.


Injecting for the Visually Impaired

If you have a vision disorder, it may be a challenge to draw up a correct insulin dose.

The following suggestions can help to ensure an accurate dose.

  • If your vision impairment is mild, an insulin pen might be easier for you to use than a syringe because the dose is dialed into the pen and there's no scale to read. Talk with your healthcare professional to decide whether a syringe or a pen is right for you.
  • Use a BD Magni-Guide™ device, which magnifies the size of the markings on a syringe and holds the bottle and syringe in place while you're drawing your insulin.
BD Magni-Guide™
  • Let a family member draw up syringes for you to inject. If family members or other non-professionals help you, make sure they receive education on how to draw up insulin from a diabetes nurse educator. Encourage them to get this training as soon as possible, even if your eyesight is still good enough to draw insulin unassisted.

  • Have a caregiver or family member double-check your syringes before you inject to make sure that you've drawn the proper amount.

Remembering Your Insulin Injections

It is not unusual for people who inject daily to forget whether they took one of their injections. Forgetting whether or not you took a scheduled injection can affect your glucose levels and your overall health. To help you remember, you can record your insulin injections in a blood glucose diary.

You can choose to merely note that you injected, or if you change your dose from time to time, you can record the time of your insulin injections; the dosage amount; the insulin type; and notes about your injection that might be important. You can design the diary yourself or print a BD blood glucose diary.


* Hirsch LJ, Gibney MA, Albanese J, et al. Comparative glycemic control, safety and patient ratings for a new 4 mm x 32G insulin pen needle in adults with diabetes. Curr Med Res Opin. 2010; 26 (6): 1531–1541.


The BD Diabetes Learning Center describes the causes of diabetes, its symptoms, and diabetes complications such as retinopathy and neuropathy. This site contains detailed information about blood glucose monitoring, insulin injection and safe sharps disposal. Interactive quizzes, educational literature downloads and animated demonstrations help to teach diabetes care skills.

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