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Excessive Needle Bruising Conundrum

Jun 25, 2019

A physician asked me to see his patient, a middle-aged woman who was using an insulin pen.  She had extensive bruising at her injection sites, with no simple explanation.  She was not taking any medications associated with increased bleeding, and did not bruise easily otherwise. The physician wondered if there was something else about her injection technique that produced the bruising.

I asked her to explain to me how she did injections.  She knew all the steps, and said she used a new needle with each injection.  Talking with her did not give me any hints about what was producing the bruising, so I asked her to show me how she gave injections using a saline pen (since it was not the right time to give more insulin).  I asked her to explain each step as she did it.


Step by step, she did everything exactly according to the pen instructions.  Then, following the injection and with the needle still under her skin, she rotated the pen and needle, saying, “And now I am rotating my site.”

I explained to her what the phrase “rotating the site” is intended to mean.  A week later, she had no new bruising at her injection sites.

Lesson Learned:   Never Assume!

It is never a good idea to assume that a seasoned individual with DM is injecting correctly. Always ask to see them go through each step so you can review their technique to see if there is something they might improve upon.  Below you will find a map to display and to record injection sites.

Ann Williams, PhD, RN, CDE





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