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LIPOHYPERTROPHY: the State of the Art
Ken Strauss, MD
Global Medical Director, BD
Director Safety in Medicine, European Medical Association
Lypohypertrophy
Picture courtesy of Nurse Ruth Gaspar, Madrid, Spain
Seven landmark studies
Frequency
Causes
Histopathology
Absorption
Glucose control
Insulin reductions
Cost savings
LH is common
15.9% (Kashi et al 2008)
27.1% (Raile et al. 2001)
34.5% (Partanen, Rissanen 2000) 48.0% (Kordonuri et al 2002)
57.0% (Teft 2002)
Have you ever noticed swelling of fatty tissue or small bumps at your injection sites?
48%
said yes*
*2009 ITQ Survey
44,6
USA
44,6
RUSSIA
45,6
NETHERLANDS
54,2
BELGIUM
50,4
FRANCE
51,7
SPAIN
44,6
ITALIA
73,3
SWITZERLAND
54,2
UK IRELAND
56,6
DENMARK
60,0
SWEDEN
52,2
GERMANY
31,1
CHINA
33,1
TURKEY
30,0
PORTUGAL
88,0
FINLAND
De Coninck C, et al. Results and analysis of the 2008-2009 Insulin Injection Technique Questionnaire survey. J Diabetes. 2010 Sep;2(3):168-79.
What is your experience?
Seven landmark studies
Frequency
Causes
Histopathology
Absorption
Glucose control
Insulin reductions
Cost savings
Results:
Frequency lipohypertrophy : 48.8%
Three independent risk factors :
Using insulin for long time (p=0.001),
Giving injection in same place (p=0.004),
Reusing the same needle (p=0.004).
.
Could there be other causes?
Seven landmark studies
Frequency
Causes
Histopathology
Absorption
Glucose control
Insulin reductions
Cost savings
How is insulin absorbed in lipohypertrophy?
Seven landmark studies
Frequency
Causes
Histopathology
Absorption
Glucose control
Insulin reductions
Cost savings
Diabetes Care 2005; 28:2025-2027
Continuous glucose monitoring system
Shows the patient not only concrete moments,
but provides a global vision of the situation
Medtronic ?
Injection in lipohypertropy
Average= 220 mg/dl; SD = 66
Insulin = 33 U/day
Injection in healthy area
Average= 155 mg/dl; SD = 47
Insulin = 28 U/day
Do you think of lipohypertrophy in patients with unsta
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