Insulin absorption in lipohypertrophy is poor
A new study has confirmed people with type 1 diabetes do not absorb insulin effectively when injecting into lipohypertrophy (LH).
The Glucose Clamp study, was conducted by Famulla et al, which used a clamp to maintain blood glucose concentration for 24 hours in all subjects, followed by regular insulin injections into LH or normal tissue.
Conducted by Hövelmann et al, all participants in the mixed meal tolerance test were fed exactly the same meals.
Insulin was injected prior to food consumption into normal tissue for one meal and into LH for the other to measure blood glucose concentration and insulin absorption.
When injected into LH, the insulin concentration in the blood stream was 37 per cent lower in the first four hours and the maximum insulin concentration was 34 per cent lower.
When injected into LH, there was a 27 per cent reduction in Glucose Infusion Rate.
The two studies give evidence for the first time that insulin is not absorbed effectively when injected into LH, which has long been associated with poor insulin association.
A previous study in 2013 revealed 39.1 per cent of participants with LH had unexplained hypoglycaemia, compared to 5.9 per cent without, but this is the first time the link has been proven.
People with diabetes can help to avoid lipohypertrophy through good injection technique and the use of 4mm pens.
Evidence suggests that those who suffer from LH tend to fail to rotate injection sites on a regular basis, inject into small injection zones and engage in needle re-use.
Insulin activity within the first five hours was reduced by 46 per cent when injecting into LH.
Post-meal blood glucose concentrations significantly increased when injecting insulin into LH, whereas injecting into normal tissue lead to a 25 per cent post-meal glucose reduction.
Maximum blood glucose concentration was also reached 15 minutes later when injecting into LH.
The study authors concluded that insulin injection into LH impairs insulin absorption leading to deterioration in after meal blood glucose control.