Clinical Problems Associated with Diabetes Mellitus
Grant N. Pierce, Robert E. Beamish, Naranjan S. Dhalla in Heart Dysfunction in Diabetes, 2019
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
Immunosuppressants, rheumatic and gastrointestinal topics
Evelyne Jacqz-Aigrain, Imti Choonara in Paediatric Clinical Pharmacology, 2021
The habitual and repetitive use of the same injection site by young people with T1DM can lead to alterations in the proliferation of adipose tissue at the site of injection. Lipohypertrophy refers to the proliferation of adipose tissue, which results in the appearance of lumps, which, while unsightly, are not in themselves dangerous. However, the absorption of insulin from these sights is impaired and can lead to increased unpredictability in glycaemic control. Lipoatrophy is less commonly seen and refers to the excessive loss of adipose tissue at a repetitively used injection site.
Neuroendocrine disease
Philip E. Harris, Pierre-Marc G. Bouloux in Endocrinology in Clinical Practice, 2014
Pegvisomant is a pegylated recombinant 191 amino acid analog of human GH. It has eight mutations at site 1 that increase binding to the GH receptor. It has a further mutation at site 2 that inhibits binding to the GH receptor. As a result, the molecule acts as a competitive GH receptor antagonist by inhibiting receptor dimerization.29 Pegylation of four or five moieties results in an increased half-life of 72 h, with reduced immunogenicity. The drug is given by s.c. injection. It is indicated for the treatment of acromegaly. Treatment with 10–30 mg daily has resulted in the normalization of IGF-I in >90% of patients in clinical trials.30,31 The fall in IGF-I is mirrored by similar reductions in serum IGF-binding protein-3 (IGFBP-3) and acid-labile subunit (ALS). In contrast, however, serum GH levels more than double.30 The drug is well tolerated, with dose-related improvements in symptomatic and metabolic parameters. In particular, in contrast to SS analogs, glucose homeostasis tends to improve. Unlike SS and DA analogs, the drug does not target the somatotroph adenoma. Although there have been concerns about the possibility of tumor growth with pegvisomant, there is no evidence of this response at present. Hepatotoxicity has been reported in patients treated with pegvisomant, usually in the form of elevated transaminases. These levels frequently return to normal, even if treatment is continued. A direct causal relationship has however been demonstrated in a few patients on rechallenging with pegvisomant. In the ACROSTUDY observational registry, the frequency of abnormal liver function tests ≥3 times the upper limit of normal was 2.5%. In consequence, all patients treated with pegvisomant should be regularly monitored. Local injection site reactions, including lipohypertrophy, are occasional complications.32
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.
Is insulin intoxication still the perfect crime? Analysis and interpretation of postmortem insulin: review and perspectives in forensic toxicology
Published in Critical Reviews in Toxicology, 2020
Charline Bottinelli, Nathalie Cartiser, Fabien Bévalot, Laurent Fanton, Jérôme Guitton
Insulin therapy is prescribed to diabetic patients as replacement for partial or total HI secretion deficiency or insulin resistance. There have been numerous studies and developments in administration route, but subcutaneous (SC) injection is still the most common. Injection can be performed by the patient with a syringe or insulin pen, or scheduled through an external insulin pump (Shahani and Shahani 2015). The injection site can be the arm, thigh, buttock, or abdomen, and must be changed regularly as repeated injection may cause local lipohypertrophy that could delay absorption (Batalis and Prahlow 2004) and then insulin could be released in a second time implying hyperinsulinemia. Intravenous (IV) administration is limited to emergency care. Individual insulin requirements are between 0.4 and 1.0 IU/kg/day (American Diabetes Association 2018) but could be potentially superior and adjusted for each patient, entailing regular follow-up with daily glycemic measurement (Idris et al. 2018).
Self-reported lipodystrophy, nutritional, lipemic profile and its impact on the body image of HIV-1-infected persons, with and without antiretroviral therapy
Published in AIDS Care, 2020
Lismeia Raimundo Soares, Jorge Simão do Rosário Casseb, Daniela Cardeal da Silva Chaba, Leandro Oliveira Batista, Luis Vinicius de Alcantara Sousa, Fernando Luiz Affonso Fonseca
More recently, new indicators of central fat and waist-to-height ratio (WHR) to identified metabolic changes and cardiovascular disease risk (CVD) in people living with HIV (Beraldo et al., 2018). In another study found lipodystrophy, high abdominal adiposity and metabolic changes in more than 48% of its sample (Beraldo et al., 2017). Futhermore, trunk lipohypertrophy occurred in a significant and increasing way in both sexes, but in males. The risk of developing lipoatrophy was twice as high as in females (Abrahams, Levitt, Lesosky, Maartens, & Dave, 2016). These findings corroborate our findings and are of great concern, as increased waist circumference is associated with increased mortality in HIV-infected indiviudals. Possible these findings are related to the adipose tissue has an important contribution to clinical and metabolic syndrome, as mechanism of adipocyte differentiation are the main targets of antiretroviral action. The most our study participants were sedentary, where 76.7% of HIV/AIDS patients reported no practice any kind of physical activity and it has shown great potential to positively modulate people's lives, improving musculoskeletal fitness, reducing body fat and the risk of cardiometabolic diseases (Da Costa, Lourenço de Arruda Neto, Félix Câmpelo, & Luiza de Rezende Ferreira Mendes, 2017).
Related Knowledge Centers
- Diabetes
- Lipoatrophy
- Pharmacokinetics
- Skin
- Insulin
- Hypertrophy
- Adipose Tissue
- Subcutaneous Administration
- Scar
- Navel