Insulin Shot Dependent Lipodystrophy: Evidence, Uncertainties and Current Terminology Overlaps

Strollo, Felice

doi:10.15406/jdmdc.2016.03.00067

Cited by 4 publications

(1 citation statement)

References 22 publications

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“…LH is the most common complication of insulin injection [59][60][61][62] or infusion [63,64], with prevalence rates of 50% or higher. Risk factors for LH appear to be longer time on insulin, more daily injections, failure to carefully rotate injection sites, and extensive reuse of needles [59,[65][66][67][68].…”

Section: Lipohypertrophymentioning

confidence: 99%

Optimal Insulin Delivery

Frid¹,

Hirsch²,

Strauss³

2019

Ultimate Guide to Insulin

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Insulin therapy is only effective if it is delivered into the right tissue in the right way. Exogenous insulin is intended for the subcutaneous (SC) tissue, not the muscle or skin. If delivered into the latter, its absorption (pharmacokinetics (PK)) and action (pharmacodynamics (PD)) are unpredictable, which often leads to poor glucose control. Correct insulin therapy begins with matching the insulin to the site used. Typically, four sites are used for insulin injection or infusion: the abdomen lateral to the umbilicus all the way to the flanks, the anterior lateral upper half of the thigh, the deltoid region of the arm, and the upper outer quadrant of the buttocks. Regular insulin and neutral protamine Hagedorn (NPH) are both absorbed more rapidly from the arm and abdominal sites and more slowly from the thigh and buttocks. The newer insulin analogs, both rapid-and slow-acting, do not appear to be influenced by the site used for injection. In order to avoid intramuscular (IM) injections, patients should use the shortest needles currently available (the 4-mm pen needle and the 6-mm syringe needle). Very young children should raise a skin fold and inject into it even when using the 4-mm needle. Giving injections with the 6-mm needle at a 45° angle converts this needle into the equivalent of the 4 mm. Injection sites should be rigorously rotated, with the new injection being approximately 1 cm from previous injections. This measure helps prevent the most common complication of injection therapy, lipohypertrophy (LH). Injecting into LH leads to unstable PK and PD and deregulated glucose control, manifested as unexpected hypoglycemia, glycemic variability, and elevated HbA1c values. Comprehensive insulin deliver recommendations have recently been published.

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Section: Lipohypertrophymentioning

confidence: 99%

Optimal Insulin Delivery

Frid¹,

Hirsch²,

Strauss³

2019

Ultimate Guide to Insulin

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Insulin-Related Lipohypertrophy in Hemodialyzed Diabetic People: a Multicenter Observational Study and a Methodological Approach

Gentile

Strollo²,

Satta³

et al. 2019

Diabetes Ther

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Introduction End-stage renal disease (ESRD) is associated with increased cardiovascular mortality (CVM) and diabetes mellitus (DM), which in many cases is treated with insulin. Skin lipohypertrophy (LH) very often occurs in insulin-treated (IT) patients as a consequence of inadequate injection technique and is one of the most prominent contributors to hypoglycemia (HYPO), glycemic variability (GV), and poor metabolic control (PMC). Method The aim of our multicenter observational study was to assess LH prevalence at self-injection sites and any possible factors predicting high LH/HYPO rates and GV in 296 dialyzed ITDM patients characterized by 64 ± 7 years of age, 7 ± 2 years disease duration, 2.6 ± 2.2 years dialysis duration, preferred pen utilization (80%), and basal-bolus regimen (87.4%) with self-injections (62.6%) largely surpassing caregiver-assisted ones (16.9%), and a mix of the two injection methods (20.5%). Results LH was detected in 57% of patients. Univariate analysis followed by backwards stepwise multivariate logistic regression function showed increased odds for developing LH in patients characterized by needle reuse, smaller injection areas, missed injection site rotation, higher HbA1c levels, and more prominent rates of HYPO and GV. Conclusion This was the first time such observation was made. It is now time for further studies aimed at providing evidence also in ESRD ITDM patients for the cause–effect relationship among wrong injection behavior, LH, and poor metabolic control and for the long-term preventative role of suitable educational countermeasures. Electronic supplementary material The online version of this article (10.1007/s13300-019-0650-2) contains supplementary material, which is available to authorized users.

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