The Subcutis Ultrasound Map of Type 1 Diabetic Children Improves the Diagnosis of Local Dystrophies and Insulin Injection Technique

Abstract

The motivation of this article is to diagnose local insulin related dystrophies and their dynamic with an ultrasound (US) subcutis (SC) map, by comparison with clinical data. To improve insulin injection technique by identifying the real cutis/subcutis thickness (CST).We have enrolled 53 type 1 diabetic children (33 boys and 20 girls, aged between 2 and 15 years), with diabetes duration between 1 and 13 years. The clinical examination puts into evidence three types of local dystrophies: hypertrophy, nodular lumps and atrophy. The US technique has confirmed clinical findings and moreover has diagnosed their location, size, depth and echostructure. While mapping dystrophies we simultaneously have taken into consideration the CST of the nearest non-injured areas in order to be compared. The screening was also made again after a 6 months period.The US interrogation revealed a larger diversity of dystrophic phenomenon than the clinic one: SC diffuse hypertrophy, dominant nodular aspects, atrophies, associated muscular dystrophy or multiple layer dystrophies. After a 6 months period of not injecting, the clinical examination diagnosed the remission of some hypertrophies and nodular aspects. Also as a confirmation, the US technique identified more residual images and certified which types of echostructures had recovered or not.Local insulin dystrophy would be diagnosed, typified and mapped effectively by US unlike clinical severity. Reinjecting would be safer done after the US re-examination has certified the level of recovery. Being a comparative term as well as a condition for improving the injection technique the mapping of normal CST might be also part of a continuous specific education of insulin treated patients.

A Systematic Review of Ultrasound-Detected Lipohypertrophy in Insulin-Exposed People with Diabetes

“…In terms of tissue morphology, the reported characteristics showed mainly increased echogenicity in diffuse areas of the injected subcutaneous tissue, some with clearly defined nodules of different sizes embedded within the area with circumscribed margins [ 19 , 24 , 27 , 28 , 33 ]. Kapeluto et al [ 33 ] define this further as nodules not having a capsule or vascularity, which differentiates the US signature of LH from haematomas or fluid-filled cysts, which do have capsules.…”

“…Kapeluto et al [ 33 ] define this further as nodules not having a capsule or vascularity, which differentiates the US signature of LH from haematomas or fluid-filled cysts, which do have capsules. In some cases, the centre or part of these LH nodules could be hypoechogenic possibly representing fluid from oedema or fat necrosis [ 19 , 27 , 28 ]. Perciun and Mihu [ 28 ] also showed reduced echogenicity when the sites had been rested for 6 months, suggesting dissipation of the LH, but not in all cases and particularly not in those showing greater fibrosis of the fat tissue (echogenicity), or in those with possible necrosis at baseline scan.…”

“…In some cases, the centre or part of these LH nodules could be hypoechogenic possibly representing fluid from oedema or fat necrosis [ 19 , 27 , 28 ]. Perciun and Mihu [ 28 ] also showed reduced echogenicity when the sites had been rested for 6 months, suggesting dissipation of the LH, but not in all cases and particularly not in those showing greater fibrosis of the fat tissue (echogenicity), or in those with possible necrosis at baseline scan. The study by Perciun and Mihu [ 28 ], which included 10 children (19% of the cohort), reported the presence of LH in cases with insulin exposure of as little as 2–5 months.…”

“…Perciun and Mihu [ 28 ] also showed reduced echogenicity when the sites had been rested for 6 months, suggesting dissipation of the LH, but not in all cases and particularly not in those showing greater fibrosis of the fat tissue (echogenicity), or in those with possible necrosis at baseline scan. The study by Perciun and Mihu [ 28 ], which included 10 children (19% of the cohort), reported the presence of LH in cases with insulin exposure of as little as 2–5 months. Thickening of the dermal layer and loss of a clear delineation between the subcutaneous and dermal layer at the injection site was noted in two papers and was identified as a potential inflammatory response to repeated insulin exposure [ 24 , 27 ].…”

Insulin-induced lipohypertrophy: clinical and ultrasound characteristics

“…Однако в некоторых случаях липогипертрофии незаметны при визуальном осмотре и пальпации. Сообщалось, что точность диагностики липогипертрофий может быть повышена с помощью ультразвукового исследования (УЗИ) [7,8,10]. Вместе с тем в настоящее время стандартные протоколы ультразвуковой оценки мест введения инсулина у больных СД отсутствуют.…”