Insulin Injection Into Lipohypertrophic Tissue: Blunted and More Variable Insulin Absorption and Action and Impaired Postprandial Glucose Control
Abstract
Objective Lipohypertrophy (LHT) is common in insulin-treated patients but its exact impact on insulin absorption and action is unclear. Research design and methods 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. Results 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 Conclusions Insulin absorption and action are blunted and considerably more variable with LHT injection, leading to profound deterioration in postprandial glucose control.
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Lipohypertrophy is common and typically occurs when the same sites are repeatedly used for injections or pump sites; it leads to use of higher insulin doses and is a cause of glycemic variability, leading to both hyper- and hypoglycemia.
“Lipohypertrophy is common and typically occurs when the same sites are repeatedly used for injections or pump sites; it leads to use of higher insulin doses and is a cause of glycemic variability, leading to both hyper-and hypoglycemia (95,96).”
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- Authors
- Famulla, S., Hövelmann, U., Fischer, A., Coester, H.-V., Hermanski, L., Kaltheuner, M., Kaltheuner, L., Heinemann, L., Heise, T., & Hirsch, L.
- Affiliations
- Profil Institute for Metabolic Research (DE)
- Gemeinschaftspraxis Kaltheuner, Leverkusen, Germany
- Becton Dickinson (United States) (US)
- Corresponding author
- Heise, Tim
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2016-07-13
- Volume
- 39
- Issue
- 9
- Pages
- 1486-1492
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2471195373
- Cited by
- 173
- References
- 3
- Citations by year
- 2026: 16 · 2025: 14 · 2024: 9 · 2023: 17 · 2022: 19 · 2021: 24 · 2020: 18 · 2019: 13 · 2018: 25 · 2017: 14 · 2016: 4
- FWCI
- 18.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Dermatology › Skin Diseases and Diabetes
- Health Sciences › Medicine › Emergency Medicine › Intramuscular injections and effects
- Keywords
- lipohypertrophy, insulin absorption, insulin action, insulin lispro, type 1 diabetes, postprandial glucose control, subcutaneous insulin injection, within-person variability, hypoglycemia, hyperglycemia, euglycemic clamp, mixed meal tolerance, adipose tissue
- MeSH terms
- Adult, Aged, Blood Glucose, Diabetes Mellitus, Type 1, Female, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Injections, Subcutaneous, Insulin, Lipodystrophy, Male, Middle Aged, Glucose Clamp Technique, Cross-Over Studies, Postprandial Period, Insulin Lispro
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