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Lipohypertrophy: does it matter in daily life? A study using a continuous glucose monitoring system
Author(s) -
Overland J.,
Molyneaux L.,
Tewari S.,
Fatouros R.,
Melville P.,
Foote D.,
Wu T.,
Yue D. K.
Publication year - 2009
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/j.1463-1326.2008.00972.x
Subject(s) - interquartile range , medicine , continuous glucose monitoring , insulin , area under the curve , diabetes mellitus , type 1 diabetes , endocrinology , pharmacokinetics , adipose tissue
Aims: To use continuous glucose monitoring (CGMS) to compare glucose profiles in people with type 1 diabetes following injection of insulin into an area affected by lipohypertrophy vs. an area not affected by lipohypertrophy. Methods: Eight patients with type 1 diabetes underwent 72 h of CGMS while following a standardized diet and injecting all insulin either into an area with or without lipohypertrophy. Patients underwent two testing periods in random order, separated by 4 days. On day 1 of each test subjects were admitted for measurement of insulin and plasma glucose levels immediately prior to, and hourly for 4 h following, a standardized lunch. Results: Insulin area under the curve (AUC) 0–4 h was similar for both test periods; 656; interquartile range (IQR): 518–1755 (normal tissue) vs. 602; IQR: 382–1436 (lipohypertrophic tissue), z = 1.7, p = 0.09. There was also no difference in the median time to maximal insulin concentration (Time max 2 h; IQR: 2–3 h; z = 0.6; p = 0.6). There was a 37.5% increase in mean plasma glucose levels following a standardized meal; however this was not significant between sites (AUC 0–4 h t = −1.7; p = 0.1). Moreover, there was no difference in CGMS profiles (AUC 1–72 h t = −0.9; p = 0.4) across the 72‐h monitoring period. Overall the prevalence of hypoglycaemia (CGMS readings < 4 mmol/l) was similar between injection sites (11.6 vs. 10.6%, p = 0.1). Conclusion: The pharmacokinetic and pharmacodynamic effect of injecting into lipohypertrophic tissue is small in comparison to the usual clinical variation observed with insulin injections.