Questions and Answers
Am I Losing Insulin When I Bleed After an Injection?
Q: When giving myself an insulin injection, about one out of every 20 times, I will bleed. What I want to know is, does that mean that I got the insulin, or does the insulin come out with the blood?
A: A few years ago, as part of an other study, we found the answer to this question. Occasionally, insulin leaks back to the skin from the injection. This is usually only a small amount and is more common in people who are overweight. The amount is small and usually not clinically significant. There was no difference, however, in the leakage back to the skin when there was bleeding and when there was no bleeding. Thus, the specific answer to your question is that you got the insulin injected properly and that there was no additional leakage, even though there was bleeding.
A more serious type of leakage occurs with insulin pens, when the needles are left on the pens between injections. Under these conditions, air enters the cartridge and the injection takes so long that insulin is usually still dribbling from the pen after it is removed from the skin. You can miss up to 2/3 of your injection when this happens. To prevent this, you should remove the needle after each injection and replace it before the next, or else leave the pen in the skin for 10 to 15 seconds or until there is no leakage after the pen is removed.
Barry H. Ginsberg, MD, PhD
Vice President of Medical Affairs
Becton Dickinson and Company
Puberty+Diabetes+My Teenage Daughter+Me= Please Help!
Q: Everything right now is a fight for my teenage daughter with diabetes. She is 1 out of 6 children in our family and seems very angry that she is the only one who has diabetes. When my daughter has high levels, she is unbearable. She has since moved in with her father (we are divorced), but she will probably be back soon since he doesn't know how to take care of her.
I would like to get her blood sugar under control. It has been out of control since she was diagnosed at 11. Her doctor is now working on getting her an insulin pump, which she has wanted for almost 2 years. He thinks it will help her get better control.
Recommend any good books? I try to be sympathetic. I realize it must be hard for her to be 13, in school and to watch all of the other kids drinking cokes and eating candy bars. Would counseling help?
Wilmington, North Carolina
A: It sounds as though you and your daughter have a number of issues to be resolved. First of all, you are right that 13 is a difficult age for everyone, and to have to deal with diabetes, poor control and a divorce is more than many kids might be able to handle. All of these losses can cause grief responses that manifest themselves in a variety of ways.
Yes, counseling would help give her some support and insight into her behavior. Often, her pediatrician or school guidance counselor can recommend a good counselor in your area. A positive relationship with a counselor may give her the boost she needs to get over this difficult hump.
You are very wise to listen to your daughter. She may need you to truly listen to how rough it is and what her struggles are, as well as give her strength to deal with her issues. It is important for her to see that she can turn something unfortunate into a strength.
Some parents and siblings help their teen by listening and allowing them to wallow in their grief for a while, then gently guiding them toward "getting over it." Although you feel sorry that she has diabetes, it is important that you not be over-pitying, which can contribute to her own self-pity.
Insulin pump therapy might improve her quality of life and give her a greater sense of control over things. That is important to evaluate.
With regard to your request for a book, have you seen "In Control: a Guide for Teens with Diabetes?" It is available from John Wiley and Sons, or you can check out the Web site www.diabetes.fyi.net.
Jean Betschart, MN, RN, CDE
Children's Hospital of Pittsburgh