Metabolic consequences of incorrect insulin administration techniques in aging subjects with diabetes
- 21 January 2010
- journal article
- research article
- Published by Springer Science and Business Media LLC in Acta Diabetologica
- Vol. 48 (2), 121-125
- https://doi.org/10.1007/s00592-009-0172-x
Abstract
Only few insulin-treated (IT) people with diabetes mellitus (DM) reach the target due to poor compliance and/or to sedentary lifestyle and/or to inadequate treatment regimen. The latter may be also brought about by often overlooked factors including insulin injection into altered skin areas, often brought about by incorrect habits, namely needle reutilization or poor compliance to the suggestion to continuously rotate skin injection areas. The aim of our study was to evaluate the rate of skin lesions within the sites commonly used for insulin injection in our IT DM patients and to verify whether a short-acting insulin analogue yielded different metabolic effects when injected in altered vs. normal skin areas. One hundred and eighty well-trained IT people with type 1 and type 2 DM (64 ± 15 years of age) consecutively referring to our unit underwent a standard clinical examination involving an accurate skin inspection protocol meant at looking for any alterations eventually affecting all possible injection sites, including bruising, multiple needle pricks and lipodystrophic nodules (LN). They were also tested for HPLC HbA1c determination and asked to fill in a standard questionnaire on injection habits. Furthermore, seven male, T1DM glulisine–glargine basal-bolus-treated patients in this group were randomly injected 10 IU glulisine into either normal skin (NS) or an LN by a nurse before a standard, 405 kcal breakfast, for blood glucose and free insulin determination at 0, 30, 45, 60, 75, 90, 120 and 150 min. More lesions were found in people over sixty (P < 0.01) and in women (P < 0.05). A higher prevalence of HbA1c >7.5% was found in patients with lesions (with an O.R. of 3.74) and further confirmed by data obtained from head-to-head comparison of insulin injection into an LN and NS. In fact, injection into an LN proved to impair and slow down insulin absorption, resulting in a higher absolute value and a larger variability of blood glucose levels than those observed by utilizing NS. This suggests us to pay more attention to all aspects of patient–team relationship to try and obtain good metabolic control in all people with diabetes and even more in the elderly.Keywords
This publication has 14 references indexed in Scilit:
- Human Insulin Analog–Induced LipoatrophyDiabetes Care, 2008
- Rimonabant as an adjunct therapy in overweight/obese patients with type 2 diabetes: replyEuropean Heart Journal, 2007
- The management of lipohypertrophy in diabetes careBritish Journal of Nursing, 2007
- Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 DiabetesThe New England Journal of Medicine, 2005
- Reproducibility and variability in the action of injected insulinDiabetes & Metabolism, 2005
- Nodules of fibrocollagenous scar tissue induced by subcutaneous insulin injections: a cause of poor diabetic controlHeart, 2004
- Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 DiabetesThe New England Journal of Medicine, 2003
- Skin-Related Complications of Insulin TherapyAmerican Journal of Clinical Dermatology, 2003
- Insulin lipohypertrophyJournal of the American Academy of Dermatology, 1990
- Insulin injection sites in diabetes--a neglected area?BMJ, 1981