How to Inject Semaglutide: Complete Step-by-Step Guide

Understanding Semaglutide Injections

Semaglutide is administered via subcutaneous injection—meaning the medication goes into the fatty tissue layer between skin and muscle. This is different from intramuscular (into muscle) or intravenous (into vein) injections.

The subcutaneous route allows for slow, steady absorption of the medication into your bloodstream, maintaining consistent levels throughout the week. Proper technique is crucial not only for comfort but also for ensuring the medication works as intended.

Choosing Your Injection Site

Semaglutide can be injected in three main areas. Each has advantages and considerations:

1. Abdomen (Belly)

Most Popular Choice: The abdomen is the preferred site for most patients due to its larger surface area and generally higher comfort level.

• Where exactly: Anywhere on your belly, at least 2 inches away from your belly button
• Advantages: Easy to reach, larger area for rotation, typically has adequate subcutaneous fat
• Tips: Avoid the area directly around your belly button and any surgical scars
• Best for: Most people, especially those new to injections

2. Thigh

The front or outer thigh provides another excellent injection site with good subcutaneous tissue.

• Where exactly: Front or outer portion of thigh, midway between hip and knee
• Advantages: Easy to access while sitting, good alternative if abdomen is uncomfortable
• Tips: Avoid the inner thigh (too many blood vessels and nerves)
• Best for: People who prefer not to inject in the abdomen

3. Upper Arm

The back of the upper arm is the least commonly used site due to difficulty reaching it yourself.

• Where exactly: Back of upper arm, in the fatty area
• Advantages: Provides rotation option, can be less sensitive than other areas
• Challenges: Difficult to reach yourself; may need assistance
• Best for: Rotation when you have help, or those very flexible

Site Rotation: Why It Matters

Rotating injection sites is crucial to prevent lipodystrophy—changes in subcutaneous fat tissue that can occur with repeated injections in the same spot. This can appear as lumps, dents, or thickened areas of skin.

Rotation Strategy

• Never inject in the exact same spot two weeks in a row
• Move at least 1 inch away from your last injection site
• Divide your abdomen into quadrants (imagine a tic-tac-toe grid) and rotate through them
• Keep a log if needed—many people use the L/R pattern (left abdomen, right abdomen, left thigh, right thigh)
• Allow each site to rest at least 4 weeks between injections

Pro tip: Some patients find it helpful to mark their injection days on a calendar with which site they used, making rotation automatic.

Step-by-Step Injection Process

Before You Begin

1. Wash your hands thoroughly with soap and water for at least 20 seconds
2. Remove medication from refrigerator 15-30 minutes before injection to allow it to reach room temperature (cold injections are more uncomfortable)
3. Gather all supplies: Medication pen, new needle, alcohol swabs, sharps container, cotton ball or gauze
4. Check the medication: Ensure it's not expired, appears clear and colorless, and has no particles

Preparation Steps

1. Attach a new needle:
   • Remove cap from pen
   • Check that medication appears normal
   • Remove paper tab from new needle
   • Screw needle straight onto pen until secure
   • Remove outer needle cap (save this for later)
   • Remove inner needle cap and discard
2. Check medication flow (first time use only):
   • Turn dose selector to flow check symbol
   • Hold pen with needle pointing up
   • Press and hold dose button until counter shows 0
   • Check for drop of medication at needle tip
   • If no drop appears, repeat once (if still no drop after 2 attempts, use new pen)
3. Select your dose:
   • Turn dose selector until it shows your prescribed dose
   • Double-check the dose before proceeding

The Injection

1. Clean injection site:
   • Clean area with alcohol swab using circular motion
   • Let site air dry completely (30 seconds)—injecting into wet skin stings
   • Don't fan or blow on the area
2. Position the needle:
   • Hold pen like a pencil or dart
   • With other hand, gently pinch about 1-2 inches of skin and fatty tissue
   • Insert needle straight into skin at 90-degree angle
   • Push needle all the way in—don't be timid (the needle is very small)
3. Inject the medication:
   • Keep needle in skin
   • Press dose button all the way down
   • Keep button pressed and count slowly to 6 (this ensures full dose delivery)
   • Check that counter shows 0
4. Remove the needle:
   • Pull needle straight out of skin
   • Release pinched skin
   • If bleeding, apply gentle pressure with cotton ball or gauze
   • Don't rub the injection site

After Injection

1. Replace outer needle cap carefully (or use needle clipper if available)
2. Unscrew and dispose of needle immediately in sharps container
3. Replace pen cap and store pen in refrigerator
4. Record your injection (date, time, site, any reactions)

Minimizing Injection Pain

Most people report that semaglutide injections are relatively painless, but here are tips to make them even more comfortable:

Before Injection

• Allow medication to warm up: Cold injections hurt more
• Use new needles every time: Dull needles cause more pain
• Choose fattier areas: More subcutaneous fat = less pain
• Relax: Tense muscles make injections more uncomfortable

During Injection

• Insert needle quickly and confidently: Slow insertion hurts more
• Don't inject through fabric: Always expose skin completely
• Ensure skin is completely dry: Alcohol on skin stings
• Inject slowly: Give medication time to disperse (count to 6)
• Stay still: Movement during injection increases discomfort

Special Techniques

• Ice technique: Apply ice pack to site for 30-60 seconds before injection to numb area
• Numbing cream: Over-the-counter topical lidocaine can be applied 30 minutes before (check with provider first)
• Distraction: Watch TV, listen to music, or have someone talk to you during injection
• Cough method: Coughing during needle insertion can reduce pain perception

Handling Injection Site Reactions

Normal Reactions

These are common and usually resolve within 24-48 hours:

• Mild redness at injection site
• Small bruise (especially if you hit a tiny blood vessel)
• Slight swelling or bump under skin
• Mild itching
• Temporary tenderness

Managing Normal Reactions

• Apply ice pack for 10-15 minutes if swelling
• Avoid touching or rubbing the area
• Wear loose clothing over injection site
• Take over-the-counter pain reliever if needed (acetaminophen preferred)

When to Contact Your Provider

• Severe pain that doesn't improve
• Large area of redness or swelling
• Warmth and tenderness (signs of infection)
• Pus or drainage from injection site
• Fever after injection
• Severe allergic reaction (rash, difficulty breathing, swelling of face/throat)
• Hard lumps that don't resolve after several weeks

Proper Storage and Handling

Before First Use

• Store in refrigerator at 36°F to 46°F (2°C to 8°C)
• Keep in original carton to protect from light
• Do not freeze—discard if frozen
• Check expiration date before using

After First Use

• Can be kept in refrigerator or at room temperature (up to 86°F/30°C)
• Discard 56 days after first use, even if medication remains
• Keep away from direct heat and light
• Always keep cap on when not in use
• Never store pen with needle attached

Travel Tips

• Use insulated travel case with ice pack if traveling more than 2 hours
• Don't check medication in luggage—keep in carry-on
• Bring prescription label and/or doctor's letter for airport security
• Pack extra needles in case of loss or damage
• Bring sharps container or use empty water bottle as temporary container

Safe Needle Disposal

Proper needle disposal is crucial for safety—never throw loose needles in regular trash.

Disposal Options

• FDA-approved sharps container: Best option, available at pharmacies
• Heavy-duty plastic container: Empty laundry detergent bottle works well
• Community drop-off programs: Many pharmacies, hospitals, and health departments offer free disposal
• Mail-back programs: Some areas offer sharps mail-back services

Never

• Throw needles directly in trash
• Put in recycling bins
• Flush down toilet
• Recap needles with both hands (use one-handed technique or don't recap)

Troubleshooting Common Issues

Medication Leaking After Injection

Small droplet at injection site after removal is normal. To minimize: ensure you count to 6 before removing needle, and insert needle at proper 90-degree angle.

Needle Won't Attach

Ensure you're screwing needle straight onto pen, not at an angle. If still won't attach, thread may be damaged—contact your pharmacy.

Dose Selector Stuck

If you can't turn selector to your dose, there may not be enough medication left in pen for that dose. Check remaining doses indicator.

Forgot Which Day to Inject

If less than 2 days late, inject as soon as you remember. If more than 2 days, skip that dose and inject on your next scheduled day. Never double up.

The Bottom Line

Proper injection technique becomes second nature with practice. Most people find that after 3-4 injections, the process feels routine and takes less than 2 minutes from start to finish.

The key principles—site rotation, proper technique, and following safety guidelines—ensure you get the full benefit of your medication while minimizing discomfort and complications.

If you're ever unsure about any aspect of your injection technique, don't hesitate to ask your healthcare provider or pharmacist for a demonstration. Many providers offer video demonstrations or in-person training sessions.