B12 injection basics

Yes, it's true - it is possible to do your own intra-muscular injections.

Intramuscular injections are quite easy to do yourself at home. As insurance becomes more problematic, doctor's office appointments become more expensive and the income many patients can direct toward basic health care declines, many patients may want to learn to self-inject their medicines, including B12.

Of course the first thing to do is talk to your doctor. He/she may be reluctant to prescribe your B12 for home injection, as it lessens their ability to

** be sure you are taking your medicine safely and as directed
** monitor your progress and health

A frank discussion with your health care provider as well as providing your doctor with assurances that you will be a safe and compliant patient, usually will yield most patients a trial of self-injection as well as lessons on how to do it properly. If you have not been compliant with medicines in the past, this may be difficult for you to attain. Remember that your doctor has your best interests at heart, and in the end he/she may also be held accountable if something goes wrong. Sometimes, including another member of the family as someone to whom you will be accountable between office visits, is helpful in making your doctor feel comfortable with turning over these injections to you at home. This is a serious matter...B12 is necessary for your body, and without it you will suffer significant neurologic damage and even death. Done incorrectly, anything from infection to tissue damage could result, so consider this option as seriously as your doctor is.

I discovered that even after having given Intramuscular injections (IM) to thousands of animals, and allergy shots to myself and my kids through the years, when it came time to do it myself - to myself- at home - I was glad to have a video to remind me of the steps. Here is one by a nurse that can be found on Youtube.

Done correctly, the process is nearly painless. Some helpful hints my family and I have discovered through the years are included in the following IM injection steps we were taught:

PREPARATION BEFORE INJECTION
1. Wash your hands
2. Lay out all your supplies
3. Temporarily numb the area to be injected with an ice pack wrapped in a paper towel or cloth
3. Disinfect the rubber top of the bottle of medicine using an alcohol swab

PREPPING THE SYRINGE AND SITE
4. Remove the syringe from the package. I tear it halfway down, then grab the needle thru the plastic wrapping and push/twist it on tightly to be sure it is not going to come off accidentally. I leave the wrapper connected from the bottom half down and pull out the needle/syringe. Keep the wrapper handy.
5. Remove the needle cap. Do NOT touch the needle to anything. If you accidentally touch it to something, either exchange the needle with a sterile one, or start over with a new syringe and needle package.
6. Pull back the plunger to the desired dosage to fill the syringe with an appropriate amt of air.
7. Poke the needle into the center of the rubber top of the vial and push in the air by depressing the plunger. (Note: If it is a new vial, you'll have to remove the safety top first)
8. Make sure the tip of the needle is in the medicine left in your vial. Hold it upright as you have been taught by the nurse or doctor. Pull back the plunger again to the appropriate dosage your doctor has prescribed and instructed you to take (usually 1cc, but not always, so take ONLY as directed) If you have a question, do not proceed, call your doctor for instructions, or go to the office for help.
9. With the needle pointed up, tap the syringe until all air bubbles have gone to the top, then slightly depress the plunger until they have been pushed into the vial. If this removes too much medicine, pull the plunger back until the bottom of the plunger is at the correct dosage. Remove the needle from inside the medicine vial and replace the plastic or metal cap over the needle. Place the needle and syringe back into the wrapper (making it easy to find) until you are ready to inject it. B12 is extremely sensitive to light, so I cover it with a towel or a pillow until I'm ready for it.

MY FAMILY'S INJECTION TECHNIQUE
11. Thigh- To find the right point to inject, I stand normally and comfortably relaxed, fingertips outstretched with arms to my side. The spot on my leg at the end of my middle finger is where I am going to put the needle. If you want, you can mark it with a pen or sharpie until you're used to the correct placement.
10. I sit comfortably on the bed, back against the wall behind me with my leg laid straight and relaxed on the mattress. I place a towel under my thigh because the ice pack often leaks water that I don't want soaking my bed. This places the towel in an easy to reach spot if I need it later. (I have had medicine accidentally leak and not been prepared. oops!)
11. Swab the injection site with alcohol until it's clean and disinfected.
12. Remove the filled syringe from the package next to my leg and on the towel, and remove the protective cap, holding the syringe in my right hand.
13. Support the muscle (slightly to the side of the center of my thigh) with my left hand by pinching thumb and forefinger lightly together and making a muscle-mountain with the injection site at the top.
14. 'Throw' the needle into the injection site, or go very slowly - whichever works best for you. My family finds that going very, very slowly minimizes any discomfort. Many find that, like a bandaid, the quicker it goes in the less you feel it. You may also find that breathing slowly out at this point is helpful. Daughter even looks away. Be sure the needle goes all the way in. It's important that the B12 goes into the muscle, not into the fat layer below the skin.
15. Pull the plunger backward to check for any backflow of blood. If you see blood, remove the needle and start again.
16. If there is no visible blood in the syringe, very slowly push the plunger until the medicine is emptied into the site. I usually choose to watch TV and go very slowly. Stay relaxed. My kids like to concentrate on breathing slowly out, or holding a conversation with me to distract themselves. There's no hurry, and no reason not to relax during the process.
17. When the medicine is all in, you can pull out the needle, release the muscle with your left hand and put the cap on, but be ready with the alcohol swab as there is often a tiny dot of medicine that may follow the needle out, or drip from it onto your skin. A little pressure may make it feel better too. We hold the swab there a few minutes if we've used an ice pack, as it takes a little before the circulation returns and any bleeding usually happens.

FINISHING UP
18. Place a bandage on the site if you want.
19. Place the needle, or the needle and syringe into your sharps container, discarding it as you were taught at the doctor's office.
20. You're finished! Now you can go on about your day as usual, knowing you have taken a real step in caring for your physical health as well as your financial well-being.

Please note, these steps are the ones my family uses for our own injections. They are provided here as a quick at-home reference, to encourage patients to have an open conversation with their physicians, and to show how easy the process really is. This post (and any others on the WEGO Health site) is not to be mistaken for medical advice of any kind. If you are going to self-inject, you need to get your instructions from your doctor and follow them closely. And, practice, practice, practice makes perfect.

The first time you do an IM injection on your own is always the toughest. Hang in there - you can do it! Give yourself plenty of time, and ask a family member or friend for moral support if it helps. That said, self-injecting is not for everyone, and it may be helpful to know that many doctors and nurses are adept at injecting others, but go white as a sheet when faced with injecting themselves. Like my daughter, you can get past this with a little time, patience and practice. For us, it was well worth the effort.

Some B12 facts:

B12 is a water soluble vitamin necessary for neurologic health and human life. Unlike other water soluble vitamins, the liver can store up to 3 years worth of B12. B12 is bound to animal protein and is not found in vegetables or fruits. It can be difficult to absorb properly by some people, especially those taking certain types of medicines, those with low or missing levels of a special stomach acid, or those with malabsorption issues. Vegetarians may have low B12 levels but are more likely to be able to absorb B12 orally since their deficiency is related to their diet and not their digestive system. B12 levels are unfortunately rarely tested by physicians, but accurate tissue levels are best found by testing homocysteine and methylmalonic acid levels. B12 levels should be over 500 for basic neurologic health, with levels under 400 known to cause neurologic damage that can become permanent. B12 deficiency used to be thought of as a rare condition, but more recent research has begun to show that it is actually quite common, especially as we age. This deficiency wreaks havoc on the nervous system of its victims, and only at the last and worst stages does it cause a specific type of anemia which can be hidden by folic acid supplementation. Among other processes, B12 and a process called Methylation that is dependant on B12, plays a vital role in the formation of neurotransmitters, conversion of the thyroid hormone T4 to T3, elimination of harmful homocysteine linked to heart disease and stroke, and maintenance of the myelin sheath that protects nerves. B12 acts as an anti-inflammatory. B12 can be taken by some people as a sublingual tablet, or even as a nose spray. The sublingual OTC tablets may be found at most drug stores/pharmacies. The nose spray is fairly new to the US and more difficult to dose, is difficult to find, very expensive and often not covered by insurance. People who find themselves suffering fatigue often find relief with B12 supplements, as do many trying to lose weight.