scholarly journals The role of proper insulin injection technique training FOR achieving of good glycaemic control

2018 ◽  
Vol 21 (5) ◽  
pp. 419-424
Author(s):  
Inna V. Misnikova ◽  
Valeriya A. Gubkina ◽  
Alexander V. Dreval
Keyword(s):  
Glycemic Control ◽  
Insulin Dose ◽  
Insulin Injection ◽  
Injection Technique ◽  
Good Glycemic Control ◽  
Daily Insulin ◽  
Daily Insulin Dose ◽  
Good Glycaemic Control ◽  
Patients With Diabetes ◽  
The Uk

Inappropriate injection technique leads to incorrect insulin dosing, increased pain and impaired glucose control in patients with diabetes. This review examines in detail the results of two clinical studies, the Glycemic Impact of Insulin Injection Technique (GIIIT) and the UK Lipo Study (UKLS) that examined the effect of teaching patients proper injection techniques to achieve good glycemic control. The GIIIT study included patients with type 1 and type 2 diabetes (1870 years) who were on a regimen of multiple daily insulin injections. They were categorised into three groups: those that received structured injection technique training using 4-mm injection needles (TN), those that received injection technique training (T) and control (C). The UKLS study included 75 patients who received structured training to reduce the risk of developing lipohypertrophy. Initially, deviations from proper insulin injection technique were observed in a majority of patients in both the studies. In the GIIIT study, 6 months after training under TN and T conditions, HbA1c decreased by 1%, with no observable changes under the C condition. The daily insulin dose was increased by 6 IU in all conditions. Overall, the use of 4-mm short needles reduced post-injective pain in all patients. In the UKLS study, for 6 months, the variability of glycemia and frequency of unexplained hypoglycaemia decreased as the daily dose of insulin decreased by an average 6 IU; in addition, HbA1c level decreased from 8.6% to 8.2%. Six months after the training, both studies noted a decrease in or disappearance of lipohypertrophy in the patients. These results indicate that proper injection technique training improves glycemic control in patients with diabetes.

scholarly journals MON-703 Injection Technique over Insulin Dose - Nuances in Diabetes Therapy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Neha Mehrotra ◽  
Daniel Kotok ◽  
Carla J DeJesus ◽  
Mary T Korytkowski ◽  
Sann Yu Mon
Keyword(s):  
Glycemic Control ◽  
Insulin Therapy ◽  
Direct Observation ◽  
Insulin Dose ◽  
Insulin Injection ◽  
Insulin Requirement ◽  
Injection Technique ◽  
Periodic Review ◽  
Major Barrier ◽  
Daily Insulin

Abstract Introduction Optimal insulin injection technique is crucial for therapeutic success in patients with diabetes who require insulin therapy for glycemic control. One of the causes for failure to reach glycemic goals can be attributed to improper injection technique. Problems related to poor injection technique may arise at a later stage and hence, may lead to a major barrier to intended glycemic control. We present a patient with worsening glycemic control and significant insulin requirement due to ineffective injection technique. Our case highlights the importance of direct observation of the patient injecting insulin, even for those who have been on insulin therapy for years. Case Presentation A 55-year-old woman with T2DM and Class III obesity was referred for endocrine consultation with HbA1c >12% for 9 months despite adhering to 4.7 unit/kg/day basal bolus daily Insulin, Metformin 1000 mg twice daily and liraglutide 1.8 mg daily. Secondary causes of insulin resistance were ruled out. Initial review of injection technique on an insulin-injection pad failed to identify the error. However, a leakage was observed when patient was asked to demonstrate injection technique on herself, using the BD AutoShield Duo needle, which she was using at that time. Patient was advised to switch to BD nano needles and given proper training. Following this adjustment, her HbA1c improved to 6.9% within 3 months with a decrease in daily insulin requirement to 1 unit/kg/day. Discussion In optimizing glycemic control, proper insulin injection technique is as essential as the appropriate type and dose of insulin; however, this is often overlooked. Studies assessing proper insulin injection technique by direct observation are limited. Problems experienced by patients are rarely brought up and often neglected during the follow-up visits. Supervision of injection technique periodically can help identify injection errors. The BD AutoShield Duo offers the distinct advantages of concealing the needle which benefits those who have an aversion to needles and reduces the risks of accidental needlesticks. The force required to deliver a successful injection of insulin using this needle is greater in comparison to traditional needles. Such force and lack of direct visualization may potentially lead to failure of insulin delivery. Such challenges may be more obvious in patients with obesity. Our case highlights the importance of periodic review of insulin injection technique, particularly when glycemic control is suboptimal, and emphasizes the correct choice of insulin pen needle. References 1.King, Laila. “Subcutaneous insulin injection technique.” Nursing Standard, vol. 17, no. 34, 2003, p. 45+. Academic OneFile, https://link.galegroup.com/apps/doc/A130629162/AONE?u=googlescholar&sid=AONE&xid=5f28fd49. Accessed 18 Nov. 2018.

Efficacy of Sulfonylureas with Insulin in Type 2 Diabetes Mellitus

2003 ◽  
Vol 37 (11) ◽  
pp. 1572-1576 ◽  
Author(s):  
Mary U Kabadi ◽  
Udaya M Kabadi
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Insulin Dose ◽  
C Peptide ◽  
Daily Insulin ◽  
Daily Insulin Dose ◽  
Sulfonylurea Drugs

BACKGROUND: In subjects with type 2 diabetes mellitus, glycemic control deteroriates while patients use sulfonylurea drugs during the course of the disease. Adjunctive therapy with insulin at this stage requires a lesser daily insulin dose in comparison with insulin monotherapy while restoring desirable glycemic control. However, data regarding direct comparison between various sulfonylureas in this regard are lacking. OBJECTIVE: To examine comparative efficacies of adjunctive therapy with insulin in subjects with type 2 diabetes manifesting lapse of glycemic control while receiving various individual sulfonylurea drugs. METHODS: Four groups of 10 subjects, each presenting with glycosylated hemoglobin (HbA1C) >8.0% while using either tolazamide, glyburide, glipizide Gastrointestinal Therapeutic System (GITS), or glimepiride, were recruited. Two from each group were randomized to receive placebo; the others continued the same drug. Pre-supper subcutaneous 70 NPH/30 regular insulin was initiated at 10 units and gradually increased and adjusted as necessary to attain fasting blood glucose levels between 80 and 120 mg/dL and maintain the same range for 6 months. Fasting plasma glucose, plasma C-peptide, and HbA1C concentrations were determined prior to the addition of insulin and at the end of the study. Daily insulin dose and changes in body weight (BW) were noted at the end of the study, and the number of hypoglycemic events during the last 4 weeks of the study was determined. RESULTS: Daily insulin dose (units/kg BW), weight gain, and number of hypoglycemic events were significantly lower (p < 0.01) in subjects receiving sulfonylureas in comparison with placebo. However, the daily insulin dose alone was significantly lower (p < 0.05) with glimepiride (0.49 ± 0.10; mean ± SE) than with other sulfonylureas (tolazamide 0.58 ± 0.12, glyburide 0.59 ± 0.12, glipizide GITS 0.59 ± 0.14). Finally, a significant correlation (r = 0.68; p < 0.001) was noted between suppression of plasma C-peptide level and the daily insulin dose among all participants. CONCLUSIONS: By lowering the daily insulin dose, sulfonylurea drugs appear to improve the sensitivity of exogenous insulin in subjects with type 2 diabetes mellitus manifesting lapse of glycemic control. Moreover, glimepiride appears to possess a greater insulin-sparing property than other sulfonylureas.

Improvement of Glycemic Control by Re-education in Insulin Injection Technique in Patients with Diabetes Mellitus

2013 ◽  
Vol 30 (10) ◽  
pp. 897-906 ◽  
Author(s):  
Yuki Nakatani ◽  
Mihoko Matsumura ◽  
Tsuyoshi Monden ◽  
Yoshimasa Aso ◽  
Takaaki Nakamoto
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Insulin Injection ◽  
Injection Technique ◽  
Patients With Diabetes

Abstract 597: Plasma Fibrin Clot Strength in Patients With Diabetes Mellitus Measured by Thrombelastography

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Benjamin Maatman ◽  
Glen Schmeisser ◽  
Janelle Owens ◽  
David Flockhart ◽  
Rolf P Kreutz
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Insulin Dose ◽  
Fibrin Clot ◽  
Suspected Coronary Artery Disease ◽  
Clot Strength ◽  
Platelet Poor Plasma ◽  
Daily Insulin Dose ◽  
Increased Risk ◽  
Patients With Diabetes

Background: Patients with diabetes mellitus (DM) exhibit increased risk of recurrent myocardial infarction. Maximal clot strength measured by thrombelastography (TEG) in whole blood is a risk factor for recurrent ischemic events. We hypothesized that diabetic subjects exhibit increased fibrin clot strength in platelet poor plasma and that extent of glycemic control correlates with maximal fibrin clot strength. Methods: Platelet poor plasma samples were obtained from subjects with known or suspected coronary artery disease prior to cardiac catheterization (n=354). Kaolin activated TEG was performed in citrate plasma. Time to fibrin formation (R), clot formation time (K), and maximal fibrin clot strength (MA) measured. Hemoglobin (Hgb) A1C and daily administered insulin doses were recorded. Results: Fibrin MA was increased among subjects with DM as compared to non-DM (37.0 ± 8 mm vs. 34.1 ± 8; p<0.001). HgbA1c was significantly correlated with MA (r=0.213; p=0.002). There was no significant correlation between daily insulin dose and MA among patients with insulin dependent DM (r=0.04; p=0.8). In multivariable regression analysis, DM remained significantly associated with plasma MA after adjustment for other clinical variables (p=0.01). Conclusions: DM is associated with elevated fibrin clot strength (MA). In addition, increased MA appears to be associated with worse glycemic control as defined by HgbA1C. Our results support that patients with DM, in particular those subjects with poor control, demonstrate more stable fibrin generation than subjects without DM. This may in part contribute to the increased ischemic risk in patients with poorly controlled DM.

scholarly journals Diabetes Mellitus with Poor Glycemic Control as a Consequence of Inappropriate Injection Technique

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Ramesh Sharma Poudel ◽  
Shakti Shrestha ◽  
Sushma Bhandari ◽  
Rano Mal Piryani ◽  
Shital Adhikari
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Blood Sugar ◽  
Basal Insulin ◽  
Blood Sugar Level ◽  
Insulin Injection ◽  
Poor Glycemic Control ◽  
Injection Technique ◽  
Premix Insulin ◽  
Patients With Diabetes

Majority of patients with diabetes mellitus (DM), who are on insulin therapy, use insulin pen for convenience, accuracy, and comfort. Some patients may require two different types of insulin preparations for better glycemic control. We have reported a case of poor glycemic control as a consequence of inappropriate insulin injection technique. A 57-year-old man with type 2 DM had been using premix insulin 30 : 70 for his glycemic control for the last 12 years. On follow-up visit, his blood sugar level (BSL) had increased; therefore the treating physician increased the dose of premix insulin and added basal insulin with the aim of controlling his blood sugar level. Despite these changes, his BSL was significantly higher than his previous level. On investigation, the cause of his poor glycemic control was found to be due to inadequate delivery of insulin (primarily premix) as a consequence of lack of priming and incompatibility of single insulin pen for two cartridges. His basal insulin was discontinued and the patient along with his grandson was instructed to administer insulin correctly. After correction of the errors, the patient had a better glycemic control.

scholarly journals The Initial Assessment of Daily Insulin Dose in Chinese Newly Diagnosed Type 2 Diabetes

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Jing Ma ◽  
Huan Zhou ◽  
Hua Xu ◽  
Xie Chen ◽  
Xiangyu Teng ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glucose Level ◽  
Insulin Infusion ◽  
Insulin Dose ◽  
Newly Diagnosed ◽  
Daily Insulin ◽  
Daily Insulin Dose ◽  
New Onset

Background. It has been well accepted that insulin therapy is the ideal treatment for newly diagnosed diabetic patients. However, there was no study about assessment of the initial insulin dosage in new onset Chinese patients with type 2 diabetes.Research Design and Methods. 65 newly diagnosed patients with type 2 diabetes (39 males/26 females; HbA1c ≥ 11.80 ± 0.22%) were investigated. All patients had random hyperglycaemia (at 21.8 ± 3.9 mmol/L) on the first day of admission and received insulin infusion intravenously (5 U/per hour). When the blood glucose level dropped to around 10 mmol/L, patients were then transferred to continuous subcutaneous insulin infusion (CSII). The reduction of blood glucose levels in response to per unit of insulin (RBG/RI) was recorded. The target glucose level was achieved in about 3 days. The total daily insulin dose (TDD) and basal insulin dose (TBD) were calculated.Results. TDD was 45.97 ± 1.28 units and TBD was 19.00 ± 0.54 units. TBD was about 40% of the total daily insulin requirement. There was a negative correlation between the ratio of RBG/RI and TDD.Conclusions. TDD was correlated with blood glucose reduction in response to intravenous insulin infusion in Chinese new onset patients with type 2 diabetes.

scholarly journals Degradation of Insulin Amyloid by Antibiotic Minocycline and Formation of Toxic Intermediates

2021 ◽  
Author(s):  
Wakako Mori ◽  
Keisuke Yuzu ◽  
Nadine Lobsiger ◽  
Hideo Nishioka ◽  
Hisako Sato ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Human Insulin ◽  
Insulin Injection ◽  
Subcutaneous Insulin ◽  
Insulin Absorption ◽  
Insulin Analogs ◽  
Diabetes Therapy ◽  
Toxic Species ◽  
Patients With Diabetes ◽  
Initial Appearance

Abstract Insulin balls, localized insulin amyloids formed at subcutaneous insulin-injection sites in patients with diabetes, cause poor glycemic control owing to impairments in insulin absorption. Our previous study has shown that some insulin balls are cytotoxic, but others are not, implying amyloid polymorphism. Interestingly, the patient with toxic insulin balls had been treated with antibiotic minocycline, suggesting a possible relationship between toxicity of insulin balls and minocycline. However, the direct effect of minocycline on the structure and cytotoxicity of the insulin amyloid is still unclear. Herein, we demonstrated that that minocycline at physiological concentrations induced degradation of insulin amyloids formed from human insulin and insulin drug preparations used for diabetes patients. Interestingly, the process involved the initial appearance of the toxic species, which subsequently changed into less-toxic species. It is also shown that the structure of the toxic species was similar to that of sonicated fragments of human insulin amyloids. Our study shed new light on the clarification of the revelation of insulin balls and the development of the insulin analogs for diabetes therapy.

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