How often should the injection site be rotated for Basaglar (insulin glargine)?

Basaglar (Insulin Glargine) Injection Site Rotation Protocol

For optimal glycemic control and to prevent complications, Basaglar injection sites should be rotated systematically, changing the zone of the body used for insulin injections regularly, using one zone quadrant/half per week. 1

Recommended Rotation Schedule

• Divide each injection area (abdomen, thighs, buttocks, upper arms) into quadrants or halves 1
• Rotate systematically within one area before moving to another area 1
• Change the zone of the body used for insulin injections regularly, using one zone quadrant/half per week 1
• Inject at least 1 cm (approximately the width of one adult finger) from previous injection sites, rotating in a consistent direction 1

Recommended Injection Sites

• Abdomen: Within boundaries approximately 1 cm above symphysis pubis, 1 cm below lowest rib, 1 cm away from umbilicus, and laterally at the flanks 1, 2
• Thighs: Upper third anterior lateral aspect of both thighs 1, 2
• Buttocks: Posterior lateral aspect of both upper buttocks and flanks 1, 2
• Upper arms: Middle third posterior aspect 1, 2

Proper Injection Technique

• Use 4-mm pen needles inserted at 90° angle for all adults regardless of age, sex, ethnicity, or BMI 1
• If using needle lengths >4 mm, use a correctly lifted skinfold to avoid intramuscular injections 1, 3
• Allow insulin to come to room temperature (leave out of refrigerator for 30-60 minutes) before injecting to reduce pain and prevent lipodystrophy 1
• Clean injection site with alcohol swab and allow to dry before injection 1
• Do not inject into areas with lipodystrophy, inflammation, scars, or damaged skin 2

Importance of Proper Rotation

• Systematic rotation of injection sites reduces the risk of lipodystrophy (pits or thickened skin) 1, 4
• Lipodystrophy can lead to unpredictable insulin absorption and increased glucose variability 4, 5
• Injecting into lipodystrophy areas may be painless, which may lead to incorrect preferential use of these sites 1
• Proper rotation can reduce the size and number of lipohypertrophy lesions 4

Storage Recommendations

• Store unopened Basaglar in refrigerator at 36°F to 46°F (2°C to 8°C) 2
• Once opened, Basaglar can be stored at room temperature below 86°F (30°C) for up to 28 days 2
• Do not freeze Basaglar or expose to direct heat or light 2

Monitoring and Follow-up

• Healthcare professionals should review rotation practices at least annually 1
• Patients should be taught to self-inspect sites and distinguish healthy from unhealthy tissue 1
• All patients who inject insulin should have their sites checked at every regular visit, or at least once a year 1

Common Pitfalls to Avoid

• Avoid injecting into the same spot repeatedly - this can cause lipohypertrophy which affects insulin absorption 1, 4
• Avoid injecting cold insulin - this can be painful and contribute to lipodystrophy development 1
• Avoid injecting through clothing - this prevents proper site examination and verification of needle penetration 1
• Avoid using the arm for self-injection without assistance - it may be difficult to ensure optimal 90° angle or perform a skin lift independently 1