Insulin Hypertrophy

Figure 60 Effect of adding twice-daily soluble insulin injections to a regimen based on twice-daily intermediate-acting (isophane) insulin. Many newly presenting type 1 diabetes mellitus patients who have residual endogenous insulin secretion can be controlled with twice-daily isophane, two-thirds in the morning and one-third in the evening. However, if postprandial hyperglycemia is pronounced, soluble insulin can be added to one or both injections. Alternatively, fixed mixtures of soluble insulin and isophane can be tried

Factors Influencing Insulin Absorption

Figure 61 Once insulin has been injected subcutaneously, many factors may influence the rate of its absorption. Patients need to be made aware of this as such factors may occasionally explain erratic diabetic control

Erratic Absorption

Figure 62 This patient is wearing an infuser to receive continuous subcutaneous insulin infusion (CSII) as an adjustable basal rate of insulin delivery augmented at mealtimes by patient-activated boosts. Patients employing CSII must have access to comprehensive education on its use, and to centers which can provide supervision by experienced staff and a 24-h telephone service for advice. Long-term strict control of blood glucose levels can be achieved, but this regimen is not without its problems; death may occur owing to sudden ketoacidosis if the insulin supply becomes disconnected and infusion site infections may occur

Figure 62 This patient is wearing an infuser to receive continuous subcutaneous insulin infusion (CSII) as an adjustable basal rate of insulin delivery augmented at mealtimes by patient-activated boosts. Patients employing CSII must have access to comprehensive education on its use, and to centers which can provide supervision by experienced staff and a 24-h telephone service for advice. Long-term strict control of blood glucose levels can be achieved, but this regimen is not without its problems; death may occur owing to sudden ketoacidosis if the insulin supply becomes disconnected and infusion site infections may occur

Insulin Atrophy

Figure 63 Insulin lipoatrophy manifests as depressed areas of skin owing to underlying fat atrophy. This was common before the advent of purified porcine and, more especially, human insulin. Several rare syndromes of lipoatrophy associated with diabetes have been described, and are characterized by insulin-resistant diabetes and absence of subcutaneous adipose tissue, either generalized or partial. These syndromes constitute a heterogeneous group, some of which are congenital and others of which are acquired

Figure 63 Insulin lipoatrophy manifests as depressed areas of skin owing to underlying fat atrophy. This was common before the advent of purified porcine and, more especially, human insulin. Several rare syndromes of lipoatrophy associated with diabetes have been described, and are characterized by insulin-resistant diabetes and absence of subcutaneous adipose tissue, either generalized or partial. These syndromes constitute a heterogeneous group, some of which are congenital and others of which are acquired

Lipoatrophy From Insulin Injections

Figure 64 This patient has both insulin lipid hypertrophy and lipoatrophy. The lipid hypertrophy is seen in the lateral thigh and buttock regions where insulin has been injected. If the same injection site is used over many years, a soft fatty dermal nodule, often of considerable size, develops, possibly owing to the lipogenic action of insulin. Patients should be discouraged from using such sites as variation in insulin absorption may occur, leading to erratic control

Figure 64 This patient has both insulin lipid hypertrophy and lipoatrophy. The lipid hypertrophy is seen in the lateral thigh and buttock regions where insulin has been injected. If the same injection site is used over many years, a soft fatty dermal nodule, often of considerable size, develops, possibly owing to the lipogenic action of insulin. Patients should be discouraged from using such sites as variation in insulin absorption may occur, leading to erratic control

Lipoatrophy Elbows

Figure 65 This patient has areas of lipid hypertrophy on both elbows. This is a highly unusual site to encounter lipid hypertrophy and a highly unusual site for insulin injection. His glycemic control, as a consequence, was very unstable but improved when he was persuaded to inject elsewhere on a rotational basis

Figure 65 This patient has areas of lipid hypertrophy on both elbows. This is a highly unusual site to encounter lipid hypertrophy and a highly unusual site for insulin injection. His glycemic control, as a consequence, was very unstable but improved when he was persuaded to inject elsewhere on a rotational basis

Figure 66 Blood glucose self-monitoring technique. A drop of blood is applied to a strip inserted into a pen meter. The drop of blood produces an electrical current proportional to its glucose concentration. No timing or wiping of the blood is necessary, although the timing sequence must be started by hand. Self-monitoring of blood glucose has become an integral part of modern insulin treatment. It allows patients to make their own adjustments to insulin dosages and helps to avoid hypoglycemia. Self-monitoring increases the patients' role in their own management and gives a greater sense of being in control of their condition. There is as yet no consensus on how often patients should check their blood glucose, and the role of self-monitoring in type 2 diabetes mellitus remains in dispute

Hypertrophy Insulin

Figure 67 The Optium Xceed meter has the unique ability to measure both blood glucose and blood ketone levels. Not only are these functions useful in hospital patients with diabetic metabolic decompensation, but also they can be very helpful in allowing diabetic patients in the community to detect impending ketosis and thus take corrective action to prevent diabetic ketoacidosis

Figure 67 The Optium Xceed meter has the unique ability to measure both blood glucose and blood ketone levels. Not only are these functions useful in hospital patients with diabetic metabolic decompensation, but also they can be very helpful in allowing diabetic patients in the community to detect impending ketosis and thus take corrective action to prevent diabetic ketoacidosis

Patient Diabetic Ketoacidosis

Figure 68 Many diabetic patients have significant visual loss due to diabetic retinopathy. Such loss makes conventional home blood glucose meters difficult to use. The newly developed SensoCard Plus meter is a novel talking blood glucose meter which uses biosensor technology to measure blood glucose and then produces the result using synthesized speech

Figure 68 Many diabetic patients have significant visual loss due to diabetic retinopathy. Such loss makes conventional home blood glucose meters difficult to use. The newly developed SensoCard Plus meter is a novel talking blood glucose meter which uses biosensor technology to measure blood glucose and then produces the result using synthesized speech

Figure 69 The MiniMed continuous glucose monitoring system is designed to monitor glucose levels in interstitial fluid, that are thought to be almost always comparable with blood glucose levels. A sensor is inserted under the skin of the anterior abdominal wall and interstitial glucose levels are sensed every 10 s and averaged over 5min. Glucose sensors are worn for a maximum of 3 days and calibrated on the basis of four or more capillary glucose readings each day. Data are stored in the monitor and downloaded to an external computer and viewed in a graphical format

Diabetes Insulin Monitor
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