Alterations in Insulin Absorption and in Blood Glucose Control Associated with Varying Insulin Injection Sites in Diabetic Patients

Abstract

In seven insulin-dependent diabetic subjects the disappearance rate of 125I-labelled short-acting insulin from injection sites in the abdominal wall was 86% greater than from the leg (P less than 0.005) and 30% greater than from the arm (P less than 0.05). Absorption from the arm was 40% greater than from the leg (P less than 0.05). The postprandial rise in plasma glucose concentration varied inversely with the rate of insulin absorption and was 30 to 50 mg/dL less after abdominal than after leg injection; the glycemic response after arm injection was intermediate between that after leg and abdominal injection. These results indicate that changing the insulin injection site from the leg to the abdomen or arm accelerates the absorption of insulin and diminishes the postprandial rise in plasma glucose. Varying insulin injection sites within the same anatomic region rather than between different regions may diminish daily variations in insulin absorption and in metabolic control in insulin-dependent diabetic subjects.

Subcutaneous adipose tissue blood flow varies between superior and inferior levels of the anterior abdominal wall

“…7 However, no differences in insulin absorption were found between superficial and deep subcutaneous adipose tissue. 12,13 It has been shown that the subcutaneous absorption of insulin varies according to adipose tissue depots, in nondiabetic 14 and diabetic 12,13,15 subjects. These differences have been found to correlate with blood flow in some studies [16][17][18][19] but not others.…”

Exercise and Antipsychotic Drugs

“…When the effect is small, it may go unnoticed, which is perhaps why it has not been previously reported in relation to antipsychotic treatment. The analogous effect has been well documented, however, in the context of insulin administration in patients with diabetes mellitus [14,15]. Exercise involving an extremity that is the site of insulin injection increases the absorption from the injection site and consequently increases systemic bioavailability of insulin.…”

Impact of injection sites for soluble insulin on glycaemic control in Type 1 (insulin-dependent) diabetic patients treated with a multiple insulin injection regimen

“…Thus, the purpose of the bolus component is to provide insulin delivery adequately timed to the absorption of the meal, whereas the purpose of the basal component is to provide adequate insulinisation during the night time and between meals. Obviously, insulin delivery depends on the absorption rate of the injected insulin and this has been demonstrated to vary considerably between different anatomical regions [2][3][4][5][6][7][8][9][10][11][12].…”

“…Thus, the purpose of the bolus component is to provide insulin delivery adequately timed to the absorption of the meal, whereas the purpose of the basal component is to provide adequate insulinisation during the night time and between meals. Obviously, insulin delivery depends on the absorption rate of the injected insulin and this has been demonstrated to vary considerably between different anatomical regions [2][3][4][5][6][7][8][9][10][11][12].It has been shown, that the preferred injection site for NPH insulin is the subcutaneous (s.c.) tissue of the thigh [8,[10][11][12]. Thus, this injection site produces the most constant insulin absorption rate with the smallest peak in plasma insulin [8,[10][11][12].…”

“…The absorption rate of soluble insulin from the abdominal wall is as fast as i.m. injected insulin into the thigh [4,8,13] and the absorption rate is faster than seen after s.c. injection into the thigh [6][7][8]. The consequence of a slow absorption rate of soluble insulin is relative hypoinsulinaemia after a meal and relative hyperinsulinaemia before the next meal.…”