We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Insulin Injection Into Lipohypertrophic Tissue: Blunted and More Variable Insulin Absorption and Action and Impaired Postprandial Glucose Control.
- Authors
Famulla, Susanne; Hövelmann, Ulrike; Fischer, Annelie; Coester, Hans-Veit; Hermanski, Lidia; Kaltheuner, Matthias; Kaltheuner, Lars; Heinemann, Lutz; Heise, Tim; Hirsch, Laurence
- Abstract
<bold>Objective: </bold>Lipohypertrophy (LHT) is common in insulin-treated patients but its exact impact on insulin absorption and action is unclear.<bold>Research Design and Methods: </bold>In this crossover study, 13 patients with type 1 diabetes received subcutaneous abdominal injections of 0.15 units/kg insulin lispro into LHT (confirmed by examination and ultrasound) and normal adipose tissue (NAT). On one day, a euglycemic clamp was performed with two injections each into LHT and NAT, and on another day one injection per region was given before a standardized mixed meal (75 g carbohydrates), all in randomized order.<bold>Results: </bold>Compared with NAT, LHT reduced insulin absorption (mean area under the insulin concentration curve [AUCINS0-4h] 131 vs. 165 h * mU/L [LHT vs. NAT]; Cmax 61 vs. 79 mU/L, P < 0.02, respectively) and effect (areas under glucose infusion rate [GIR] curves [AUCGIR0-4h 625 vs. 775 mg/kg, P < 0.05]) but increased intrasubject variability ([coefficient of variation] AUCINS0-4h 52 vs. 11%, Cmax 55 vs. 15%, AUCGIR0-4h 57 vs. 23%, all P < 0.01). Postprandial blood glucose (BG) concentrations were ≥26% higher with LHT (AUCBG0-5h 731 vs. 513 mg * h/dL, BGmax 199 vs. 157 mg/dL, 2-h BG 150 vs. 104 mg/dL, 5-h BG 145 vs. 81 mg/dL, all P < 0.05) and maximum concentrations occurred later. Hypoglycemia (BG ≤50 mg/dL) occurred numerically less frequently with LHT injection (two vs. six patients), whereas profound hyperglycemia (BG ≥300 mg/dL) only occurred with LHT injection (two patients). Tmax-INS did not differ between LHT and NAT in either study.<bold>Conclusions: </bold>Insulin absorption and action are blunted and considerably more variable with LHT injection, leading to profound deterioration in postprandial glucose control.
- Subjects
INSULIN absorption &; adsorption; HYPOGLYCEMIA; INSULIN shock; HYPOGLYCEMIC agents; DIABETES; BLOOD sugar analysis; SUBCUTANEOUS injections; COMPARATIVE studies; CROSSOVER trials; HYPERGLYCEMIA; INGESTION; INSULIN; TYPE 1 diabetes; RESEARCH methodology; MEDICAL cooperation; RESEARCH; EVALUATION research; RANDOMIZED controlled trials; LIPODYSTROPHY; GLUCOSE clamp technique; DISEASE complications
- Publication
Diabetes Care, 2016, Vol 39, Issue 9, p1486
- ISSN
0149-5992
- Publication type
journal article
- DOI
10.2337/dc16-0610