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Sharper focus on injection guidelines needed to address rising but preventable complications

Photo: Sharper focus on injection guidelines needed to address rising but preventable c....
Lipohypertrophy (fatty lumps under the skin), a debilitating and costly complication of sub-optimal injection technique in people with diabetes, is on the increase.  The incidence can be markedly reduced through increased awareness and regular assessment by healthcare professionals and structured patient education.

Presenting at the Australasian Diabetes Congress in Adelaide, Nurse Practitioner and Credentialled Diabetes Educator Michelle Robins said that although common, lipohypertrophy was an often overlooked sign that a patient’s injection technique may require modification.

“Studies suggest the incidence of lipohypertrophy has more than doubled over the 17 year period to 2013, affecting over 60 percent of people with diabetes,” said Michelle.

“Of greater concern is the fact that it can lead to erratic and unpredictable glucose control resulting in more frequent use of health services, but it can be prevented by establishing correct injection practices from the start,” she added.
Lipohypertrophy is a lump under the skin caused by accumulation of extra fat at the site of repeated subcutaneous injections of insulin. It can be unsightly and may change the rate at which insulin is absorbed.

Various factors are thought to contribute to the development of lipohypertrophy, including the growth-promoting properties of the insulin itself, repeated trauma when patients use the same injection site and re-using the same needle.

“All patients should be given an easy-to-follow injection site rotation plan from the beginning of therapy, and this should be reviewed at least once a year,” said Michelle.

“Also, as many as 38 percent of patients re-use needles and almost half of these are re-using the same needle between three and five times.  This is associated with a 75 to 85 percent increased risk of developing lipohypertrophy,” said Michelle.

Once lipohypertrophy has developed, the injection rotation plan needs to be reviewed and documented even more frequently to ensure patients use a new site every time they inject their medication.

“One of the reasons that patients choose to keep injecting into lipohypertrophic sites is that the skin at these sites becomes less sensitive and so they feel less pain when injecting,” said Michelle.

“If pain is a concern for patients, we can help address this by ensuring they use a new needle for every injection, and switching them to the recommended 4mm needle length,” she added.

“Comprehensive recommendations around insulin delivery and educational material have been available since 20161 so health professionals can assist and guide their diabetes patients on correct injection practices.”

Checklist for treating and preventing lipohypertrophy:

• Advise patients to stop injecting insulin into lipohypertrophic sites.

• Monitor blood glucose levels vigilantly.

• Those who switch from injecting into lipohypertrophic sites to normal tissue are at risk of hypoglycaemia. Dose adjustment may be required by a qualified healthcare professional.

• Broaden injection zones and minimise the risk of intramuscular injections by using short (4mm or 5mm) pen needles.

• Patients should be taught to space out their injections approximately 1-2cm (at least one adult fingerbreadth) from each other.

• A new site should be used for every injection.

• Stop needle re-use. Needles are single-use only.  Multiple use can cause unnecessary complications.

For educational resources and patient support materials on lipohypertrophy, visit www.bd.com/anz/diabetes

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