scholarly journals Insulin-induced lipohypertrophy: clinical and ultrasound characteristics

2018 ◽  
Vol 21 (4) ◽  
pp. 255-263
Author(s):  
Vadim V. Klimontov ◽  
Mikhail M. Lazarev ◽  
Alexey A. Makhotin ◽  
Andrey Ju. Letyagin ◽  
Lilia A. Anisimova ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Insulin Dose ◽  
Diagnostic Technique ◽  
Insulin Injection ◽  
Postprandial Glucose ◽  
Insulin Antibodies ◽  
Injection Technique

Background: Lipohypertrophy is primary dermal complication of insulin therapy. The data on the prevalence of lipohypertrophy in diabetic subjects are inconsistent, that may be due to the lack of sensitivity and subjectivity of palpation as diagnostic technique. Meanwhile, the reliability of lipohypertrophy detection can be increased by ultrasound. Aims: to compare clinical and ultrasound characteristics and to determine the risk factors of insulin-induced lipohypertrophy in diabetic subjects. Materials and methods: We observed 82 patients, including 26 individuals with type 1 diabetes and 56 subjects with type 2 diabetes. Duration of insulin therapy varied from 3 months to 37 years (median 14 years). The sites of insulin injections were assessed by palpation and ultrasound. Visualization protocol included gray-scale densitometry, strain elastography, and 3D Doppler power ultrasound. Scaled evaluation of ultrasound sings was applied. Insulin injection technique was assessed by questionnaire. Serum levels of insulin antibodies were determined by ELISA. Results: Lipohypertrophy was revealed by palpation and ultrasound in 57 and 80 patients (70% and 98%) respectively. Total lipohypertrophy area, acoustic density and total ultrasound score showed weak positive correlations with daily insulin dose (r=0.3, r=0.3 and r=0.35, respectively, all p0.006). Patients receiving insulin analogues had smaller area of abdominal lipohypertrophy than those on human insulin (p=0.03). A positive correlation was found between abdominal lipohypertrophy area and mean postprandial glucose (r=0.35, p=0.001). A rare needle change and injections in lipohypertrophy sites were the most common deviations in insulin injection technique (70 and 47 subjects, 85% and 53% respectively). The levels of insulin antibodies showed no association with lipohypertrophy parameters. Conclusions: Patients with type 1 and type 2 diabetes demonstrate high prevalence of lipohypertrophy in insulin injection sites. Ultrasonography is more sensitive method of diagnostics of lipohypertrophy compared with palpation. Insulin-induced lipohypertrophy is associated with errors in injection technique and higher insulin doses.

scholarly journals Comparison of two insulin injection methods on control of type 2 diabetes; is the new protocol effective or not?

2021 ◽  
Vol 7 (1) ◽  
pp. e10-e10
Author(s):  
Mohammad Ali Bayani ◽  
Hojjatollah Ghorbani ◽  
Roghayeh Akbari
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Insulin Dose ◽  
Insulin Injection ◽  
Regular Insulin ◽  
Diabetic Patients ◽  
Injection Methods ◽  
The Mean

Introduction: Type 2 diabetes is a progressive disease with a significant risk for developing late complications. Objectives: This study aimed to determine if the discharge NPH and regular insulin doses of conventional insulin therapy protocol in which optimal glycemic control can be achieved are similar to NPH and regular insulin doses at beginning of the insulin protocol or not. In other words, we aimed to compare two insulin injection methods on the control of type 2 diabetes. Patients and Methods: This cross-sectional study was performed on hospital records of type II diabetic patients admitted for insulin therapy with the conventional protocol from 2008-2013. Treatment was initiated with the following proportions; morning NPH: 44%, morning regular dosage: 22%, evening NPH dosage: 17% and evening regular dosage: 17%. Insulin doses of the discharge day in which optimal glycemic control has been achieved were recorded and based on their mean, a protocol was made. Finally, two groups were categorized. Group 1 consisted of patients whose discharge insulin dose was in the range of the mean data of the study (±2 IU/mL) and patients whose discharge insulin dose was in accordance with the conventional protocol (±2 IU/mL) participated in group 2. Results: At discharge day, the mean morning NPH dose was 34.2±6.69, morning regular: 23.8±6.36, evening NPH: 21.26±6.75 and evening regular: 20.74±5.51. The discharge insulin ratios of the conventional protocol were similar to that of the admission ratios in only 17.7% of the patients. Only 34.5% of the patients could include in the new protocol and 50% of them didn’t fit any protocol. Conclusion: It is suggested to inject one-third of the total daily insulin need as NPH in the morning and divide the remained two-thirds between morning regular, evening NPH and evening regular equally. This may decrease the length of hospital stay and decrease the time to reach the desired glycemic control.

Insulin Dose Adjustment Following Bariatric Surgery, a Review of Available Literature

2021 ◽  
pp. 193229682110288
Author(s):  
Lynn E. Kassel ◽  
Jessica J. Berei ◽  
Jamie M. Pitlick ◽  
Joel E. Rand
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Type 2 Diabetes Mellitus ◽  
Dose Adjustment ◽  
Insulin Dose ◽  
Appraisal Tool

Bariatric surgery is a known and effective treatment for type 2 diabetes mellitus. Patients with type 1 diabetes mellitus and exogenous insulin-requiring type 2 diabetes mellitus require adjusted insulin dosing after surgery to avoid hypoglycemia. This review describes insulin dose adjustments following a variety of bariatric procedures. After searching the available literature and assessing for eligibility, 8 articles were included. The Johns Hopkins Research Evidence Appraisal Tool for literature appraisal was used. The results of this review reveal insulin dose adjustment varies based upon surgical procedure type and time of follow-up from the procedure.

Insulin Dosage Adjustments After Initiation of GLP-1 Receptor Agonists in Patients With Type 2 Diabetes

2021 ◽  
pp. 089719002199362
Author(s):  
Mandy Chen ◽  
Etty Vider ◽  
Roda Plakogiannis
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Insulin Therapy ◽  
Basal Insulin ◽  
Insulin Dose ◽  
Retrospective Chart Review ◽  
Insulin Dosage ◽  
History Of ◽  
Bolus Insulin

Background: Combination of insulin and GLP-1RAs have shown reductions in the HbA1c, body weight, and the risk of hypoglycemia. To date, there are conflicting data regarding the effect of GLP-1RAs on insulin dosage(s). Objective: The objective of this study was to evaluate adjustments of insulin doses upon initiation of GLP-1RAs. Methods: This was a retrospective chart review of patients on insulin therapy initiated on GLP-1RAs at NYU Langone Health. Patients were included in the study if they were at least 18 years of age, history of type 2 diabetes, and were on concurrent basal or mixed insulin therapy. 45 patients met inclusion criteria and were included in the study analysis. The primary endpoint was the median change in overall basal insulin doses. Secondary endpoints included median changes in total basal, mixed, and bolus insulin doses, oral antidiabetic medications and GLP-1RA doses, HbA1c, body weight, fasting glucose, and creatinine clearance. Safety results included any adverse reactions to insulin and/or GLP-1RA. Results: In the per-protocol analysis, there was a significant reduction in overall total basal insulin doses from baseline to week 24 (50 units vs. 44 units, p < 0.05). There was a median reduction in patients receiving glargine (50 units vs. 44 units) and detemir (29 units vs. 21.5 units). Conclusions: Use of GLP-1RAs after 24 weeks resulted in a statistically significant reduction in overall total basal insulin dosages from baseline. The median HbA1C in our patient population was >8%. Consider a ≥10% reduction in the overall basal insulin dose upon initiation of GLP-1RA in patients with a HbA1C >8%.

scholarly journals Insulin Injection Technique is Associated with Glycemic Variability in Patients with Type 2 Diabetes

2018 ◽  
Vol 9 (6) ◽  
pp. 2347-2356 ◽  
Author(s):  
Lu Yuan ◽  
Fengfei Li ◽  
Ting Jing ◽  
Bo Ding ◽  
Yong Luo ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Variability ◽  
Insulin Injection ◽  
Injection Technique
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