Insulin therapy is an indispensable part of diabetes management; all type 1 and most type 2 people with diabetes require insulin at some stage. Injectable therapies like human insulin, insulin analogues and glucagon-like peptide-1 receptor agonists are used to manage diabetes. Accurate injection technique is vital for achievement of glycaemic control. Improper technique of injecting insulin may increase the risk of poor glycaemic control, due to mismatch of peak insulin effect and maximal glucose load. Improper use, or reuse, of injection devices, such as needles, may lead to disadvantageous consequences including pain with bleeding and bruising, breaking off and
 lodging under the skin, contamination, dosage inaccuracy and lipohypertrophy. Accurate injection technique and use of shorter needles (4 mm) are associated with improved blood glucose control, more satisfaction with therapy and lower requirement of insulin after only a 3-month period.

Lipohypertrophy is largely due to the local lipogenic effects of insulin. It is a common side effect of subcutaneous insulin therapy, occurring in up to 50% of patients with type 1 diabetes. The insulin injection into a site of lipohypertrophy may lead to erratic absorption of the insulin, with the potential for poor glycaemic control and unpredictable hypoglycaemia. Despite the important implications for diabetes control in insulin injecting patients, there is a dearth of knowledge and awareness in children about the subject. Diabetes self-management education may play an important role in prevention of lipohypertrophy.

How do you tackle this issue in your daily practice? Is this topic part of the diabetes self-management education courses in your country?

Information about the discussion leader

The discussion will be moderated by Dr Sunil Surajprasad Gupta, Diabetologist, Managing Director, Sunil’s Diabetes Care n’ Research Centre, Ramdaspeth, Nagpur.

References

1. Al Hayek, A.A., Robert, A.A., Braham, R.B. et al. Frequency of Lipohypertrophy and Associated Risk Factors in Young Patients with Type 1 Diabetes: A Cross-Sectional Study, Diabetes Ther (2016) 7: 259. 

2. Forum for Injection Technique (FIT), India: The Indian Recommendations 2.0, for Best Practice in Insulin Inj. 2015. 

3. Sanjay Kalra Et All, 2012, Forum For Injection Techniques, India: The First Indian Recommendations For Best Practices In Insulin Injection Technique. Indian Journal Of Endocrinology And Metabolism / Nov-Dec 2012 / Vol 16 | Issue 6.

4. Unn-Britt Johansson, Et All , Impaired Absorption Of Insulin Aspart From Lipohypertrophic Injection Sites, DIABETES CARE, VOLUME 28, NUMBER 8, AUGUST 2005

5. Robert J Young, Diabetic Lipohypertrophy Delays Insulin Absorption , Diabetes Care, Vol. 7 No. 5, September-October 1984.