[Disclaimer: I am not a medical professional. Please seek out a medical professional to take proper precautions, learn proper techniques and ask any questions before attempting a subcutaneous B12 self-injection. The information in this blog is not to be taken as medical advice and should not be treated as such. It is provided without any representations or warranties, expressed or implied. The information herein expresses my own learning experiences. Note also that the pictures demonstrate the administration of a subcutaneous B12 injection by a medical professional and do not show a self-injection taking place.]
As it turns out, vitamin B12 deficiencies are very common in those with Lyme disease – as well as in the general population! The first thing my Lyme literate specialists did when I first became ill was to test my B12 with a simple blood test; the results came back shockingly low. The consequences of not getting enough B12 can be serious: it can cause irreversible nerve damage.
Symptoms of B12 deficiency can include:
- Numbness, burning, or tingling in the hands, feet or extremities; neuropathy
- Muscle weakness, paresthesias or paralysis
- Pain, fatigue, weakness
- Confusion and mental fog
- Unsteadiness, dizziness
- Muscle cramps, twitching
- Psychiatric symptoms such as depression
- Visual disturbances, eventually even blindness
If any of these symptoms look familiar, they could be caused be a B12 deficiency, and if so, B12 supplementation can help immensely – and even reverse these symptoms. You can take B12 by mouth, but since absorption can be an issue in those with Lyme disease, the best way to get it into your system is by injecting it into subcutaneous tissue.
To learn how to self-inject, I asked my naturopath to teach me so the best advice I can give you is to book an appointment with a Naturopath, Doctor or Nurse to watch how it’s done. I would also advise that you bring a caregiver, if possible, so they can also watch and learn.
When I first began giving myself B12 injections, my naturopath explained that the best place to inject is in fat located around the upper butt. I was doubtful that I’d be able to inject myself, because I am shaky and fatigued on a good day, so I brought my husband so he could learn proper form and inject me on days I wasn’t well enough to do so. Ironically, my husband was subsequently diagnosed with pernicious anemia and now has to inject himself on a regular basis too, so it ended up being a win-win for both of us! Maybe it was fate?
Self-administering a B12 Subcutaneous Injection Into the Buttock (aka Self-inflicting Pain in the Butt)*
Why Subcutaneous and Why in the Butt?
Injecting into the upper area of the buttock is advantageous in that there are fewer blood vessels in that fatty tissue and it will absorb the B12 more slowly than in the arms or legs (but you still have to be careful not to inject into a vein).
Subcutaneous injection allows the B12 to be retained for a longer time between injections. If you’ve ever had B12 injections into the muscle of an arm or leg, you may notice your urine is pink soon after. This is an indication that the B12 is being expelled and you don’t want that.
One trick to successful subcutaneous injections is making sure the needle is inserted at a 45 or 30 degree angle (not at 90 degrees or straight up-and-down into the fat). Closer to the surface of the skin without being right under the skin is best (you will notice stained skin if you inject too shallow).
Start with the Right Prescription
There are 4 types of B12. Feel free to read up on the others, but Methylcobalamin is the most active form of B12 in the body and it’s the only you should consider. I find that I do better with a high dose, so I use a B12 strength of 5000 mcg – but that’s something to discuss with your doctor.
Have your prescription filled at a compounding pharmacy and be sure to keep the B12 in the fridge. For the sake of convenience, Haber’s Pharmacy is able to fill a prescription with already loaded syringes. Convenience comes at a price though; a friend paid around $71 for 30 pre-loaded syringes. For around the same cost, my supplies (both serum and syringes) will last over eight months!
Get Help from an Expert
On the day of my appointment, to transport the vial, I packed it up with a coldpack and brought extra syringes and alcohol wipes just in case. I had my Naturopath walk us through all the steps and inject me on the first visit. During the next visit, it was my husband’s turn to inject me. It was a good thing I brought extra syringes because my husband accidentally pricked himself when he removed the needle cover. If this happens to you, start over with a fresh needle! I can’t stress enough how important it is to practice good hygiene, which is why it’s important to learn from a Naturopath, Doctor or Nurse.
On the final visit, my Naturopath watched me inject myself so she could observe and correct any errors along the way. Once I had all those ‘trials’ out of the way, I set about practicing to do my own injections at home.
A few tips to start:
- Obtain a ‘Sharps’ container from your local pharmacy so you can dispose your syringes – these are generally available free of cost (once filled to the line, you can take it back to your pharmacy for safe disposal).
- Determine how and where you’re going to set everything up. I bought myself a cheap, low-rimmed plastic tray that I could put onto the bathroom counter to contain all my supplies. It’s also quicker to wipe down with a spritz of bleach mixed with water than cleaning the bathroom counter each time. I remove the tray after every use and store it in another room where I have more storage space.
The advantage of setting up in the bathroom is having the mirror to better see where you’re targeting the injection. It’s also extremely helpful to use the mirror to avoid injecting into any blue veins on the surface. No matter where you choose to set up, a mirror and good lighting are key.
Gather your supplies:
- Tray (you can cover the tray with a clean paper towel if you like).
- B12 vial from the fridge (Note: if you forget to refrigerate the vial after use, according to my Naturopath, it can be left out for up to 8 hours without harm — but it’s always best to check with your pharmacist if that happens just to be safe).
- Three syringes (in case you contaminate one or draw blood and have to start again).
- Alcohol and cotton balls/makeup pads or pre-treated alcohol wipes in individual packets.
- Sharps container for disposal of syringe.
Step 1 Wash and dry your hands thoroughly (you can also wear latex gloves if you wish). Wet the cotton ball with alcohol (or open the pre-treated alcohol wipe) and wipe the rubber top of the B-12 vial well in circular motions to sterilize.
Step 2 Unwrap the syringe from the plastic. Pick up the syringe, remove the needle cover (I gently push against the bottom of it until it’s released and lift it off with my left hand). Place the syringe cover on the tray facing up so you can rest the needle of the syringe in it after it’s prepped.
Pull back on the plunger to allow an amount of air in that is equivalent to the amount of B-12 you will be injecting (in my case it’s 25 cc’s so I draw back to that mark on the syringe).
Step 3 Hold the syringe in your dominant hand, being careful not to allow the needle to touch anything. You will see that the tip of the needle has an indentation; it’s best to inject with the indent pointing upward so you may have to swing the needle protector to one side. (I swing mine to the right so that I can clearly see if any blood has accidentally been drawn in Step 6).
Cradle the B-12 vial in your non-dominant hand upside down, and carefully push the needle into the rubber top. Keep the vial and syringe supported and aligned so the needle is not bent.
Press the plunger of the syringe all the way in to remove the air that was in the syringe.
Step 4 Pull back on the plunger and watch the marks on the syringe to see the amount of B-12 that you have transferred to the syringe. Stop when you get to the appropriate amount. Withdraw the needle from the vial and place the vial on the tray.
Tap (flick) the side of the syringe to force any bubbles up and out of the syringe. Gently push the bottom of the plunger until you can see a tiny bubble of serum on the needle tip; be gentle or you can send the serum flying! (Note: You may still notice a space at the top of the syringe; my ND explained that this is an ‘artifact’ that can’t be removed).
Your syringe is now prepped. Gently place it back into the needle cover you removed in Step 2, and left face up on the tray, so the needle is resting inside (do not drag it into the top or you run the risk of snagging the needle and you will have to start again).
Step 5 Line up your target area in the mirror. My ND suggests drawing an imaginary line from your tailbone to your hipbone and trying to inject within the point of a triangle. But realistically, it’s going to be the most abundant pocket of fat that’s within your reach. Wet a cotton ball with alcohol (or use an alcohol wipe) to cleanse the skin of the target area (this is where the mirror comes in handy to eye a target area where you don’t see any blue veins on the surface).
With the cotton ball, work from the centre of this area in a circular motion outward until the entire area is cleansed. Now, twist at the waist and with your non-dominant hand gently pinch the area between your thumb and fore or middle finger to grasp the fat. With your dominant hand, holding the needle like a pen, rest the side of your hand outside of the target area and pivot the needle at the cleansed area entering the skin at a 45 degree angle or less (90 degree angle would be straight into the skin).
Note the angle of the syringe is 45 degrees into the fat. Try not to inject right under the skin because of the possibility of permanently staining your skin. When you plunge into the skin with the needle, be sure to do it quickly – like throwing a dart. Inserting it slowly will cause you pain (I know this firsthand!).
Step 6 Release the fat you’re holding in your non-dominant hand and use this hand to then hold and stabilize the bottom of the syringe. With your dominant hand, pull back slightly on the plunger and look to see if you pull (aspirate) any blood back into the syringe. If all is clear, push down at a steady rate on the plunger until all the B-12 has been transferred from the syringe to the fat.
Note: If you draw blood when you aspirate, pull the needle out. It’s best to start all over again with a new syringe and B12, taking care to avoid that area. Starting fresh will allow you to see clearly when you aspirate with the second injection. In all the years I’ve been injecting, I’ve never drawn blood.
Step 7 Pull the needle out of the fat and immediately apply a fresh cotton ball and massage the area for a minute or two. Apply a band-aid to the injection site if you need one – but the needle is so tiny I find that unnecessary.
Step 8 Dispose of the syringe in the Sharps container and tidy up. Remember to put the B12 vial back into the fridge to keep it cold.
* A special thank you to my ND for her time and patience in showing me these steps and to Linda Kelso, head of the York North Lyme Support group, for peer reviewing this post. Their ongoing support and encouragement is priceless.