Insulin therapy injection site

Octreotide -synthetic peptide analogue of somatostatin -abdominal pain, nausea, vomiting, diarrhea -local injection site reactions -cholelithiasis -sweating, flushing -hyperglycemia (many patients will require insulin therapy)... 

For therapy of local lumps, extravasation, etc., one should first seek to improve the injection technique. Substitution with highly purified insulin is recommended. Injection with purified insulin into the affected area may speed up resorption of the lumps. Lipodystrophy or lipoa-trophy improve after switching to highly purified human or insulin lispro. Lipohypertrophy, on the other hand, often fails to respond to changes in the insulin regimen (161). Varying the injection site may help, but differences in absorption rate then have to be taken into account. 

Patients on long-term insulin therapy are usually trained to administer their own medication. In order to safely use insulin, it is important to provide adequate (refrigerated) storage of the preparation, to maintain sterile syringes, to accurately measure the dose and fill the syringe, and to use a proper injection technique. Patients should rotate the sites of administration (abdomen, upper thighs, upper arms, back, and buttocks) to avoid local damage from repeated injection. 

Occasional patients have antibodies to injected insulin, but the significance of the antibodies is minimal. Human insulin therapy has not totally eliminated insulin allergies, although most patients have a local reaction that will dissipate over time. If the allergic reaction does not improve or is systemic, insulin desensitization can be carried out. Protocols for desensitization are available from major insulin manufacturers. While more common in the animal insulin era, lipohypertrophy is still seen in some patients with longstanding type 1 DM. Such patients give their insulin injections in the same site to minimize discomfort. Because insulin absorption from an area of lipohypertrophy is unpredictable, avoidance of injections into these areas is mandatory. 

Insulin is a hormone produced by the pancreas. In diabetes mellitus, the body does not produce enough insulin and therapy with insulin may be required. In Bodybuilders it is utilized to increase the amount of glycogen and other nutrients introduced to the muscle cells. Insulin is very effective, but extreme caution must be used. Insulin may cause minor side effects such as rash, irritation or redness at the injection site. Too much insulin can cause low blood sugar... 

Patients with insulin-dependent diabetes receive subcutaneous insulin injections daily. The goal of insulin therapy is to provide adequate glucose control through each 24 hour period while minimizing the number of injections required to achieve that control. Repeated injections at the same site may result in atrophy or hyperplasia at the injection site. Insulin preparations of short, intermediate and long duration are available (Table 10.10). 

A 68-year-old man with type 2 diabetes treated with insulin and oral hypoglycemic agents developed pruritic plaques of more than 15 cm diameter at the site of his insulin injections. Skin biopsy showed an Arthus type reaction. Various insulin therapies, including insulin glargine, insulin detemir, and human insulin, produced the same response. Intra-dermal tests were positive to a variety of insulins and protamine. He was desensitized using subcutaneous human insulin and orally fexofenadine 180 mg bd and was then successfully treated with insulin glargine. The fexofenadine was stopped 6 months later. 

Insuhn therapy may be required in the control of type II diabetes. InsuUn is given by subcutaneous injection, usually several times a day in an attempt to mimic the normal physiological variation. The most serious risk with insulin therapy is that of hypoglycaemia. Hypoglycaemia develops if insulin is injected and not followed by a meal and is a medical emergency. Fat hypertrophy may occur if insulin is continually injected into the same site. Rotation of the sites of injection is therefore advised (30c). 

Insulin is a peptide hormone, secreted by the pancreas, that regulates glucose metabolism in the body. Insufficient production of insulin or failure of insulin to stimulate target sites in liver, muscle, and adipose tissue leads to the serious metabolic disorder known as diabetes mellitus. Diabetes afflicts millions of people worldwide. Diabetic individuals typically exhibit high levels of glucose in the blood, but insulin injection therapy allows diabetic individuals to maintain normal levels of blood glucose. 

In conclusion, the pulmonary delivery of insuhn offers an efficient and convenient therapy for diabetic patients. The feasibility of inhaled insuhn is based mainly on the lungs large absorption area of alveoli and their extremely thin walls full of intercellular spaces that make them more permeable than other mucosal sites to large proteins. Generally, inhaled insuhn showed a more rapid absorption than insulin administered by SC injection [59]. One major concern for pulmonary insuhn delivery is the unknown long-term effects of inhaled insuhn within the respiratory tract. Thus, possible long-term problems should be considered when insuhn is administered in this manner [66]. 

Drug administration route There is a greater risk of developing ketoacidosis with insulin-pump therapy than with multiple daily insulin injections, because there is always a smaller subcutaneous depot of insulin at any time with the insulin pump. However, in practice, the frequency of ketoacidosis is similar with insulin pump and insulin injections. Insulin-pump therapy can lead to some localised non-serious skin infections at the infusion site. In general, current pumps are robust and reliable, but malfunctions can still occur. [15 ]... 

---