IntroductionProper insulin injection/infusion is essential to optimize insulin absorption and action. Guidelines on insulin injection techniques are available. Lipohypertrophy (LH) is a local complication of insulin therapy, which results in erratic absorption and impaired glycemic control.MethodsChildren and adults with type 1 diabetes on insulin injection or infusion were enrolled in the study. Subjects were interviewed and filled in a questionnaire on injection/infusion routines. Sites of injection/infusion were examined by trained diabetes educators, and capillary HbA1c was obtained.ResultsOne hundred sixty-nine subjects (104 children) with type 1 diabetes were enrolled; 119 were on multiple daily injection (MDI) and 50 on insulin pump therapy. Seventy-two percent and 82% of children and adults, respectively, rotate site at every injection; 78% of pump users change infusion set and 74% rotate site at 2–3 days. Thirty-nine percent and 32% of children and adults had LH. HbA1c was lower in children and adults with no LH (P < 0.001). An association was seen between LH and rotation frequency in children (P = 0.026). LH was the most common skin complication in the MDI group, while nodules, allergy marks and hyperpigmentation were seen in pump users.ConclusionProper injection/infusion routines impact glycemic control and skin health. Education and examination of injection sites remain a crucial part of diabetes management.

Introduction. Diabetic Ketoacidosis (DKA) is a serious complication that can be life-threatening. Management of DKA needs admission in a specialized center and imposes major constraints on hospital resources. Aim. We plan to study the impact of adapting a diabetes-educator care model on reducing the frequency of hospital admission of children and adolescents presenting with DKA. Method. We have proposed a model of care led by diabetes educators for children and adolescents with diabetes. The team consisted of highly trained nurses. The model effectiveness is measured by comparing the rate of hospital admission for DKA over 4-year period to the baseline year prior to implementing the model. Results. There were 158 admissions for DKA over a 5-year period. Number of patients followed up in the outpatient diabetes clinics increased from 37 to 331 patients at the start and the end of the study years. Admission rate showed a downward trend over the five-year period. Percentage of admission for DKA is reduced from 210% to 1.8% (P 0.001). Conclusion. Diabetes educator care model is an effective and a sustainable measure to reduce hospital admission for DKA in children and adolescents.