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Things To Consider When Rotating Insulin Injection Sites

Things To Consider When Rotating Insulin Injection Sites

The more frequently you inject insulin on the same area, the greater the chance you’ll develop lipohypertrophy, the accumulation or buildup of fatty tissues under the surface of the skin. Lipohypertrophy interferes with insulin absorption, which then affects your blood sugar levels. This is why insulin site injection rotation is crucial. But, how do you properly do it? Find out here.

The Basics of Insulin Site Injection Rotation

Before we discuss how to rotate insulin injection sites, let’s first review the basic principles.

First, the appropriate injection sites in order of how quickly insulin enters the blood are:

  • The abdomen
  • The outer area of the upper arm
  • Top and sides of thighs
  • Upper, outer area of the buttocks

Since the abdomen offers the fastest absorption rate, it is often the most preferred site, especially when the blood sugar level is high.

Next, you need to decide, preferably together with your doctor, how to rotate the sites. Will you rotate within one injection site or go from one area to another for each shot depending on the time of day (i.e., thigh in the morning, abdomen at night)?

Experts say that you’ll have the best results if you consistently use one body part because it avoids variations in insulin action.

Whatever you decide, remember the following principles:

  • Stick to one pattern of insulin site injection rotation. Usually, a change in pattern is only necessary when there are changes in daily routine or blood sugar levels. Discuss things with your doctor to be on the safe side.
  • Never inject close to your belly button as that area has tougher skin, which affects insulin absorption. Choose an area that is at least 2 inches away from your navel.
  • Do not choose a site you will use for exercise if you work out right after the shot. Physical activity increases the rate of absorption, making hypoglycemia more likely.
  • If you choose to rotate within one site, allot at least one inch between each shot.
  • Avoid any area with a bruise, scar tissue, swelling, moles, or other unexplained changes in appearance.

Techniques in Insulin Site Injection Rotation

Remember that there’s no absolute technique in insulin site injection rotation, but you can consider the following:


  • Move from the right side to the left, creating one line, then go down and start from right to left again. Ensure that you’ve covered the entire abdomen first before going back to the very first injection site.
  • Inject from right side to the left, creating one line, then go down and start from left to right, sort of like following a “snake-like” pattern.
  • Divide the abdomen into quadrants (4 smaller areas) and rotate within the quadrant using a spiral pattern. Move from one quadrant to the next.


  • Go from right to left, then downward until you’ve covered one arm. Afterward, move to the next arm and follow the same pattern.
  • Go from top to bottom in one arm before moving to the other arm.


  • Divide the thighs into two lines; dedicate one line for morning injections and the other for night injections. Don’t forget to cover one thigh first before moving to the other thigh.
  • Divide things into two smaller areas and rotate within each area using a spiral pattern.

Final Reminders

Insulin injection site rotation is crucial in preventing lipos or lipohypertrophy, the accumulation of fatty tissues underneath the skin surface. Lipos affects insulin absorption, which in turn influences blood sugar levels.

There are many techniques for insulin site injection rotation. Talking to your doctor will help you determine which pattern best suits you.

Learn more about Diabetes here.

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Written by Lorraine Bunag, R.N. Updated Jul 20, 2021
Fact Checked by Hello Doctor Medical Panel