Questions and Answers

Dec 1, 1997

Beating the Bruise Blues

Q: Why does my injection site sometimes get an awful bruise? It doesn't happen all the time, so I'm wondering if something is wrong. I take two injections of insulin a day and rotate locations.

Pat Green

A: When you insert a needle it goes by small blood vessels that may rupture and cause a bruise. It would be best to avoid areas where you can see blood vessels near the surface.

Try applying firm pressure to the site after the injection. If there is any bleeding, the pressure will stop it. Do not rub the area because rubbing will cause the insulin to be absorbed more quickly because it increases circulation to the area.

Margaret Wilkman, RN, MPH, FNP, CDE
Assistant Clinical Professor, Duke University School of Nursing
Durham, N.C.

Needles and Pains

Q: Two years ago, at age 39, I was diagnosed with type 2. Sometimes the bottom of my feet feel like tiny needles are sticking all over them (not painful, just weird), sometimes hot, and sometimes they are not very sensitive to temperature, especially when it's cold. It comes and goes, and no particular conditions set it off. What is this sensation, and how do I treat it? My doctor just dismissed it.

S.L. Hawfield

A: The symptoms you describe as "pins and needles" or "hot" sensations are often associated with sensory diabetic neuropathy. It is one of the most common complications associated with diabetes. The symptoms of neuropathy can be mild, as yours are, or so severe as to be disabling.

Although there is no cure for diabetic neuropathy there are some things that can be done to decrease the symptoms. Rubbing the affected area with Ben-Gay or Aspercream helps some people. Creams that contain capsaicin (made from hot peppers) are also very effective in relieving pain and burning. Severe cases may require oral medications.

Nothing works 100 percent of the time, but tight control may also help some complications of diabetes including neuropathy.

I'm concerned that your doctor "just dismissed it." Physicians that treat people with diabetes need to address diabetic neuropathy as they would any other complication of the disease. As neuropathy progresses the feet may become numb, subjecting them to injury and potentially to amputation. Your physician would have been well advised to refer you to a podiatrist for a thorough evaluation.

Neil Scheffler, DPM, DABPS, podiatrist. Board Certified in foot and ankle surgery, Board of Directors of the American Diabetes Association, Md.-D.C.-Va. area.

Cold Feet over Diabetes

Q: How can cold feet be made to feel warmer? Can anything be done for them?

Ulysses G. Auger
Washington, D.C.

A: People with diabetes are at an increased risk for peripheral vascular disease which can result in decreased blood flow to the feet and legs. Patients with diabetes that complain of cold feet should have their circulation evaluated. Your podiatrist will check pulses, hair growth, skin texture, skin color, temperature and may perform a doppler test on the arteries in your feet.

If the circulation is poor, referral to a vascular surgeon may be indicated. Oral medications or surgery may be necessary. Exercises, such as walking, also often help increase blood flow to the lower extremities.

I often suggest to my patients with cold feet to wear two pairs of socks. The inner layer is thin and wicks perspiration away from the skin. Moist skin feels cold. The next layer is a bulkier thermal sock that insulates and also wicks moisture to the outer layers. Make sure there is plenty of room in your shoes for this bulk. Socks may also be worn to bed at night as well.

People with diabetes should never use hot water bottles or heating pads on their feet. These can cause thermal burns and may lead to dire consequences!

Neil Scheffler, DPM, DABPS, podiatrist. Board Certified in foot and ankle surgery, Board of Directors of the American Diabetes Association, Md.-D.C.-Va. area.

Insulin - Serve Chilled or Room Temperature?

Q: If a vial of insulin is refrigerated, unopened, taken on a trip and kept at room temperature for several weeks, should it be thrown out, or can it be re-refrigerated and used until it expires?

Roy K. Mullins
Livermore, Ca.

A: Since there are several factors which can affect the stability of insulin stored at room temperature, Novo Nordisk concurs with the recommendations provided by the United States Pharmacopeia Dispensing Information (USPDI) as well as the American Diabetes Association (ADA).

The USPDI provides the following information on storage of insulin vials: "An insulin bottle in use may be kept at room temperature for up to one month. Insulin that has been kept at room temperature for longer than one month should be thrown away."

The ADA states that even though each insulin vial is stamped with an expiration date, a slight loss of potency may occur after the vial has been in use for more than thirty days, especially if stored at room temperature.

Marianne Sandine, RN, BS, CDE, Product Support Associate for Wayman Wendell Cheatham, MD, medical director, Novo Nordisk
Princeton, N.J.

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