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ForumsDosing & ProtocolsInjection technique: subcutaneous depot formation and absorption — 12 month update

Injection technique: subcutaneous depot formation and absorption — 12 month update

Dr.RenalNash Mon, Nov 13, 2023 at 9:06 AM 46 replies 2,824 viewsPage 1 of 10
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Dr.RenalNash
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Nov 13, 2023 at 10:31 AM#1

Ok so I just found out I've been making several injection technique mistakes for the past 3 months and I feel like an idiot. Posting this in case anyone else is doing the same things wrong.

What I was doing wrong:

  1. Not leaving the needle in for 6-10 seconds after the click — I was pulling it out immediately and sometimes medication would leak out
  2. Injecting into the same exact spot every single time — I now have a hard lump in that area
  3. Not letting the pen reach room temperature — injecting cold medication straight from the fridge
  4. Rubbing the injection site after — apparently you're not supposed to do that??

My nurse friend watched me do an injection last week and was like "oh honey no" 💀

What other mistakes are common? Would love to hear from people who've figured out the right technique.

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Dr.RenalNash
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Nov 13, 2023 at 10:48 AM#2

The lump from injecting in the same spot is called lipohypertrophy (or possibly lipodystrophy) and it can actually affect absorption of the medication! You might have been getting inconsistent dosing because of it. The good news is it usually resolves if you avoid that area for a few months.

My injection rotation system:

  • I divide my abdomen into 4 quadrants (upper left, upper right, lower left, lower right)
  • I rotate through them each week: week 1 upper left, week 2 upper right, etc.
  • Within each quadrant, I vary the exact spot by an inch or so
  • I stay at least 2 inches away from my navel

This way I don't hit the same spot more than once a month.

Last edited: Nov 13, 2023 at 3:48 PM
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LipidDoc_ATL
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Nov 13, 2023 at 11:05 AM#3

Great thread. Injection technique is one of those things that seems simple but actually matters a lot for consistent drug delivery. A few clinical pearls:

Needle retention time: The Wegovy prescribing information recommends keeping the needle inserted for at least 6 seconds after the dose counter shows "0." This ensures the full dose is delivered. With higher doses (1.7mg, 2.4mg), some pharmacists recommend 10 seconds because the volume is larger.

Injection sites: Approved sites are abdomen (>2 inches from navel), front of thigh, and upper arm (outer area). Bioavailability is approximately 89% regardless of site, but absorption rate can vary slightly.[1]

Temperature: Let the pen sit at room temperature for 30 minutes before injection. Cold medication can cause more injection site pain and may absorb slightly differently.

No rubbing: Correct — don't rub or massage the injection site. This can cause bruising and may increase the rate of absorption, potentially worsening side effects.

Pinch technique: For most patients, pinch a 1-2 inch fold of skin and inject at 90 degrees. For very lean patients, a 45-degree angle may be more appropriate to avoid intramuscular injection.

[1] Novo Nordisk. Wegovy (semaglutide) injection, for subcutaneous use. Prescribing Information. 2023.
Last edited: Nov 13, 2023 at 4:05 PM
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nick_newbie
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Nov 13, 2023 at 11:22 AM#4

the cold pen thing — this was me for my first two months. I was literally injecting ice cold medication and wondering why it burned 😭 night and day difference once I started letting it warm up

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sarah.morrison
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Nov 13, 2023 at 11:39 AM#5

Wait you're not supposed to rub the site?? I've been doing that literally every single time because I thought it helped distribute the medication. Oops 🤦‍♂️

Last edited: Nov 13, 2023 at 12:39 PM
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