Insulin for routine treatment is given subcutaneously by intermittent injections or by continuous infusion. Insulin can be injected subcutaneously almost anywhere if there is enough flesh. The best site is the front of the thigh. The lower abdominal wall, buttocks, and upper arms may also be used. Patients who want to wear sleeveless clothes should normally avoid using the arms in case unsightly marks or fat hypertrophy should appear; some may then prefer to confine injections to the lower abdomen.
It is important to vary the injection sites from day to day, using for example, each thigh alternately over as wide an area as possible. Absorption of insulin varies from one site to another, being most rapid from the abdominal site, and less rapid from the arms and least from the legs. If there are any difficulties with "control" it is advisable to use one area consistently—for example, the thigh.
In diabetic emergencies soluble insulin is given intravenously, or occasionally intramuscularly (see chapter 9).
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