What are the guidelines for selecting and rotating Omnipod (insulin management system) sites?

Omnipod Site Selection and Rotation Guidelines

For Omnipod insulin delivery systems, inject into the abdomen, thighs, buttocks, or upper arms, rotating systematically by dividing each area into quadrants or halves and using one zone per week, with each new site placed at least 1 cm from the previous site. 1, 2

Recommended Injection Sites

The following body areas have sufficient subcutaneous fat to ensure proper insulin delivery and absorption:

• Abdomen: Within boundaries approximately 1 cm above symphysis pubis, 1 cm below lowest rib, 1 cm away from umbilicus, and laterally at the flanks 2
• Thighs: Upper third anterior lateral aspect of both thighs 2
• Buttocks: Posterior lateral aspect of both upper buttocks and flanks 2
• Upper arms: Middle third posterior aspect (least preferred for self-application as it may be difficult to ensure optimal 90° angle without assistance) 1

Systematic Rotation Protocol

Divide each injection area into quadrants or halves and rotate systematically within one area before moving to another, using one zone quadrant/half per week. 1, 2 This approach prevents lipodystrophy development and ensures consistent insulin absorption. 1

Specific rotation practices:

• Space injections at least 1 cm apart (approximately the width of one adult finger) from previous injection sites 1, 2
• Rotate in a consistent direction within each zone to maintain systematic coverage 1
• If applying two injections simultaneously (e.g., prandial and basal insulin), give them at separate injection sites 1
• Change body zones regularly, dedicating one zone quadrant or half per week 1, 2

Sites to Avoid

Never inject into areas with the following characteristics:

• Lipodystrophy lesions (soft, smooth raised areas that cause erratic insulin absorption and increased glycemic variability) 1
• Scars, stretch marks, or tattoos (impact on subcutaneous delivery and absorption rates is unknown) 1
• Edema, infection, inflammation, or ulceration 1, 3
• Through clothing (prevents proper site inspection and technique verification) 1, 3

Site Preparation

Before applying the Omnipod:

• Inspect the skin surface to ensure it is clean and intact 1
• Disinfect with an alcohol swab and allow the alcohol to evaporate completely on its own 1, 3
• Ensure insulin is at room temperature by removing it from the refrigerator 30-60 minutes before use, as cold insulin can be painful and contribute to lipodystrophy development 1, 3

Monitoring and Follow-Up

• Healthcare professionals should review rotation practices at least annually or if warning signs of poor injection technique arise 1, 2
• Examine injection sites at every regular visit, or at minimum once yearly, checking for lipohypertrophy 1, 2
• Patients should be taught to self-inspect sites and distinguish healthy from unhealthy tissue 2

Common Pitfalls

The most frequent errors that compromise Omnipod effectiveness include:

• Injecting into lipohypertrophy areas because they are painless, leading to unpredictable absorption and unexplained hypoglycemia 1, 3
• Failing to systematically rotate sites, which increases risk of lipodystrophy that causes erratic insulin absorption and increased glucose variability 1
• Using the same convenient location repeatedly rather than following a structured rotation map 1, 2
• Injecting cold insulin directly from refrigerator, which increases pain and lipodystrophy risk 1, 3

Research demonstrates that systematic rotation using tracking devices can improve rotation scores by 30% and reduce both lipodystrophy size and glucose variability within 12 weeks. 4