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Dermal manifestations of diabetes
Published in Robert A. Norman, Geriatric Dermatology, 2020
Lipohypertrophy is a reaction that occurs locally at the site of insulin injection. It has been reported as occurring at an incidence of 14% in patients with diabetes63 and has been attributed to a combination of local and systemic allergic reactions2.
Clinical Problems Associated with Diabetes Mellitus
Published in Grant N. Pierce, Robert E. Beamish, Naranjan S. Dhalla, Heart Dysfunction in Diabetes, 2019
Grant N. Pierce, Robert E. Beamish, Naranjan S. Dhalla
Complications do arise with the s.c. injection method of insulin delivery. Insulin-induced lipoatrophy (loss of s.c. fat) or lipohypertrophy (augmentation of s.c. fat) at the site of injection is well documented.71 Changing the insulin to a purer preparation or to another species has been suggested to be helpful in alleviating these problems.71 Local allergic reactions or infections of the skin at the injection site have also been observed.76 Hypo- and hyperglycemia can occur if the dosage of insulin delivered is not adequately managed.76 Most significantly, it has been found that s.c. delivery of insulin may result in insulin degradation by muscle or fat tissue which can lead to insulin resistance.77 Whether this is an important clinical problem in insulin-dependent diabetics is debatable.76
Practice Paper 1: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
Lipoatrophy describes a localized loss of fat tissue, which may occur in people with diabetes at the site of repeated subcutaneous insulin injections. Lipohypertrophy is the accumulation of fat at the point of repeated subcutaneous injections. Both of these conditions can be avoided by regularly rotating injection sites.
Subcutaneous injections: A cross-sectional study of knowledge and practice preferences of nurses
Published in Contemporary Nurse, 2023
Özlem Fidan, Arife Şanlialp Zeyrek, Sümeyye Arslan
Medications that are delivered subcutaneously such as LMWH and insulin are the medications that should be used continuously at specific periods for sustaining therapeutic effects. It is significant to perform rotations between the injection sites to minimize tissue damage, aid absorption, and avoid discomfort and lipohypertrophy (Frid et al., 2016; Gentile et al., 2016; Hirsch & Strauss, 2019). Although an administration chart was present to show and save rotation sites in subcutaneous injection, more than half of the nurses did not use this administration chart in the hospital where this study took place. This suggests a possible link between nurses’ actual lack of injection site rotation and their limited use of the hospital site administration rotation chart. Further research is required to determine the effect of site rotation charts on actual subcutaneous injection site rotation and to identify the barriers to and facilitators of injection site rotation. Turaç and Ünsal (2018) stated in their study that more than half of the nurses do not perform rotation effectively. In addition, more than half of the nurses in this study knew that rotation was effective in reducing injection-related pain. At this point, it is crucial to identify the obstacles in nurses’ use of the rotation form and the reasons for transferring knowledge to practice and make arrangements in all necessary areas (nursing management, quality system, training of nurses, etc.).
Practical aspects of insulin administration: what the healthcare provider knows
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2022
Nousheen Parker, Ankia Coetzee, Lourentia van Wyk, Magda Conradie
A study evaluating six different types of insulin pens concluded that prolonged pressure on the plunger (must be pressed down for at least 10 seconds) is required to ensure that the full intended dose is given.26 Only a small minority of study participants (13%) were aware of this important aspect of insulin injection. Needles are manufactured for single use and should be discarded immediately after the injection. If left attached to the pen, accumulation of air may occur via the needle as both ends are open, which may cause serious under-dosing.27 In addition, when leakage of unsuspended cloudy insulin occurs through the attached needle due to temperature-related expansion of insulin, the concentration of the insulin in the pen is modified. Only a third of our study participants knew that needles should be removed from the pen after each injection. In resource-limited countries and public health care systems, needles may safely be re-used up to five times.19,28 Blanco et al. found, however, that the re-use of needles more than 5 times significantly increases the risk for lipohypertrophy.29,30 Less than half (46%) of the participants knew that pens in use may be stored at room temperature. According to the FIT guidelines,31 insulin may be stored at room temperature once in use as this causes less discomfort and make it easier to re-suspend cloudy insulin.
Effect of lipodystrophy on self-esteem and adherence to antiretroviral therapy in people living with HIV
Published in AIDS Care, 2022
Larissa Rodrigues Siqueira, Gilmara Holanda da Cunha, Marli Teresinha Gimeniz Galvão, Marina Soares Monteiro Fontenele, Franscisco Vagnaldo Fechine, Melissa Soares Medeiros, Lavna Albuquerque Moreira
In this study, to be considered with lipodystrophy, the criteria should be met: diagnosis of lipodystrophy described in the patient's medical record, self-report of lipodystrophy by the patient, and clinical examination by an infectious disease doctor, considering (Alencastro et al., 2017; Finkelstein et al., 2015): (1) Lipoatrophy: reduction of fat in peripheral regions, such as arms, legs, face and buttocks, with muscular and venous prominence; (2) Lipohypertrophy: accumulation of fat in different parts of the body, mainly in the abdomen and back, gynecomastia in men and breast enlargement in women; (3) Mixed form: association of lipoatrophy and lipohypertrophy.