Patient Benefits   Helping to achieve HbA1c targets   Minimise unexplained hypoglycaemia   Lower risk of glycaemic variation   Injection comfort and adherence

 

Lower risk of glycaemic variation

Impact of glycaemic variation

Investigators Blanco et al. 1, diabetes Specialist Nurses in Spain, noticed that a number of patients frequently presented to clinic with recurring unexplained hypoglycaemia and glycaemic variation. 'They observed' a correlation between the presence of glycaemic variation and hypoglycaemia and the presence of lipohypertrophy.

They found in their study that1:

Blanco infographic Blanco infographic

 

Clinical Case Study cited in Blanco 20131

Clinical base-line characteristics and medical history:

  • 32 year old male
  • 18 year history of T1Diabetes
  • Basal bolus insulin therapy - Glargine and Lispro Total Daily Dose (TDD) 136 units
  • Levetiracetam (treatment for epilepsy)
  • 12.7mm needle with reuse >10x
  • HbA1c 6.9%
  • Referred to neurology department May 2011with history of
    • Severe nocturnal hypoglycaemia
    • Tonic-clonic seizures since August 2010
    • Multiple emergency service call outs to his home because of seizures – severe hypo noted at time of seizure requiring Glucagon IM injections
    • Brain magnetic resonance imaging (MRI) and electroencephalogram (EEG) all negative
  • Referred to Diabetes Unit in one of the study sites August 2012 – review showed:
    • Palpable lipohypertrophy lesions detected both sides of abdomen
    • Self-reported always injects into same lipohyperthrophy lesions

 

Clinical Lipohypertrophy

Lipohypertrophy example 1

 

‘Echo-signature’ of Lipohypertrophy

 

Outcome after optimal injection technique intervention:

  • Switched to 5mm pen needles (shortest available needle at the time) to minimise intramuscular risk
  • ‘Single needle use only’ instruction reinforced
    • Educated to use correct injection technique including correct rotation and to avoid injecting into lipohypertrophy lesions
  • Insulin dose reduced as a precaution against potential hypoglycaemia

 

Longer term follow up review and outcome:

  • Follow up December 2012
  • Self-reported
    • No seizures since August 2012
    • No emergency service call out since August 2012
    • No nocturnal hypoglycaemia since August 2012
    • Levetiracetam discontinued
  • Subsequent reports of 2-3 day time hypoglycaemia per week
    • Insulin dose further reduced
  • Total Daily Dose 48 units at most recent clinical review prior to publication of paper
    • Total Daily Dose of insulin reduced by 88 units compared to 136 units 5 months earlier
  • HbA1C remained 6.9%

 

References

  • 1 Blanco M, et al. Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes. Diabetes Metab (2013)
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