Insulin Injection Into Lipohypertrophic Tissue: Blunted and More Variable Insulin Absorption and Action and Impaired Postprandial Glucose Control

Famulla, Susanne; Hövelmann, Ulrike; Fischer, Annelie; Coester, Hans-Veit; Hermanski, Lidia; Kaltheuner, Matthias; Kaltheuner, Lars; Heinemann, Lutz; Heise, Tim; Hirsch, Laurence

doi:10.2337/dc16-0610

Cited by 135 publications

(128 citation statements)

References 22 publications

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“…Injecting into areas of LH reduces insulin absorption and also raises within-subject uptake variability with a coefficient of variability (CV%) that is three- to fivefold higher than when injecting into normal tissue; therefore, this practice must be avoided [24]. Clearly there is much more that can be done to raise awareness of LH as well as intervene by teaching proper site rotation and limiting needle reuse [25].…”

Section: Discussionmentioning

confidence: 99%

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

et al. 2018

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IntroductionThe 2015 Insulin Injection Technique Questionnaire survey involving 13,289 patients included 898 (6.8%) patients in the pediatric age range (≤ 18 years).MethodsThe younger patients included in the questionnaire survey were grouped according to age: Group 1 (G1), 0–6 years, n = 85; Group 2(G2), 7–13, n = 423; Group 3 (G3), 14–18, n = 390. The injection technique was evaluated by means of a questionnaire and nurse assessment.ResultsNurses found lipohypertrophy at injection sites in 41.3, 45.2, and 47.3% of patients in G1, G2, and G3, respectively. Unexpected hypoglycemia was common, ranging from 23.8 to 48.1% of patients, and glucose variability was even more common (61.0% in G1, 45.9% in G2, and 52.5% in G3); both conditions were associated with lipohypertrophy. While increasing numbers of patients were using the recommended 4-mm needles, large percentages still used longer ones (33.3% in G1, 45.9% in G2, and 61.5% in G3). The reuse of needles was also common, ranging from 21.1 to 32.5% in the three age groups. Excessive reuse, defined as using a single needle more than five times, was reported by 9.4–21.8% of patients in the three age group. The percentages of patients who had not received any injection training in the last 12 months ranged from 21.2 to 26.8% in the three groups.ConclusionImplications of our study are as follows: (1) pediatric patients should use 4-mm pen needles or 6-mm syringes (inserted at a 45° angle); (2) patients aged ≤ 6 years should always inject into a raised skin fold regardless of which device is used; (3) all patients should rotate sites and use needles only once to avoid lipohypertrophy.FundingBecton–Dickinson (BD) diabetes care.

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Section: Discussionmentioning

confidence: 99%

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

et al. 2018

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“…Case reports indicate that clinical palpation has also failed to detect lipohypertrophy with improvement in glycaemic indices once identified by ultrasonography . With accumulating evidence of altered insulin absorption dynamics at known sites of clinical lipohypertrophy , dedicated studies are required to determine if subclinical lesions such as those characterized in the present study also contribute to glycaemic variability. No difference was noted in overall glycaemic control, as measured by HbA 1c , between subgroups of participants with clinical, subclinical or absent lipohypertrophy; however, the necessary power to detect potential differences was not factored into the initial study design (data not shown).…”

Section: Discussionmentioning

confidence: 80%

Ultrasound detection of insulin‐induced lipohypertrophy in Type 1 and Type 2 diabetes

et al. 2018

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“…The main reasons could be impaired and variable insulin absorption and action when the insulin is injected into the affected tissue. [40] Frid et al . have documented significantly higher occurrence of unexpected hypoglycemia and glucose variability in patients who had LH and incorrect rotation of site.…”

Section: Discussionmentioning

confidence: 99%

An audit of insulin usage and insulin injection practices in a large Indian cohort

Baruah

Kalra

Bose

et al. 2017

Indian J Endocr Metab

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Introduction:Insulin remains the cornerstone of therapy in a substantial number of patients with type 2 diabetes mellitus (T2DM). Inadequate knowledge regarding insulin usage is likely to influence its acceptance and adherence, and outcome of therapy, underscoring great need to investigate knowledge, attitude, and practice of insulin usage in patients with T2DM.Methodology:A cross-sectional registry-based retrospective study analyzed data collected from 748 respondents (male: 466, female: 282), mostly from high or middle economic status, who were enrolled as outpatient in a referral clinic during last 10 years (2006–2016), to assess the general characteristics of patients with type 2 diabetes and their baseline knowledge, attitude, and practice of insulin usage and injection practices.Results:Mean ± standard deviation (SD) of duration of diabetes was 12.24 ± 7.60 years and mean ± SD duration of insulin therapy was 3.42 ± 4.18 years, which was initiated after a mean ± SD diabetes duration of 8.80 ± 6.42 years. Mean insulin dose per kilogram of body weight/day was 0.51 ± 0.27 units. Total daily dose of insulin was 33.36 ± 18.44 units and number of injections/day (mean ± SD) was 2.06 ± 0.73. Among the respondents, 58.96% were on human insulin and 35.70% were on analog insulin. Pen devices were used by 66.08% of the population whereas 31.76% used insulin syringes. The prevalence of lipohypertrophy (LH) was 12.57%, which was significantly (P < 0.001) associated with wrong technique with regard to injection angle (10.45% vs. 23.02%), site of injection (7.00% vs. 30.51%), rotation of site of injection (0.88% vs. 17.66%), and reuse of needle (5.77% vs. 15.19%). LH was also significantly (P < 0.05) associated with the use of human (14.74%) compared to analog insulin (8.24%).Conclusion:The current study highlights the unique patterns of insulin usage and associated high prevalence of LH among insulin users in India.

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Insulin Injection Into Lipohypertrophic Tissue: Blunted and More Variable Insulin Absorption and Action and Impaired Postprandial Glucose Control

Abstract: Insulin absorption and action are blunted and considerably more variable with LHT injection, leading to profound deterioration in postprandial glucose control.

Cited by 135 publications

References 22 publications

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

Ultrasound detection of insulin‐induced lipohypertrophy in Type 1 and Type 2 diabetes

An audit of insulin usage and insulin injection practices in a large Indian cohort

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