Insulin Injection Techniques and Skin Lipodystrophy

A special issue of Diabetology (ISSN 2673-4540).

Deadline for manuscript submissions: 30 June 2025 | Viewed by 1037

Special Issue Editors


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Guest Editor
1. Emeritus Professor of Internal Medicine, Department of Precision Medicine, Vanvitelli University of Naples, Naples, Italy
2. Research Director of Nefrocenter Research Network, Torre del Greco, Naples, Italy
Interests: diabetes; metabolism; endocrinology; hypertension; metabolic diseases; blood pressure; atherosclerosis; nutrition; internal medicines; insulin resistance; lipid metabolism; nutraceuticals; medical aerospace

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Guest Editor
Endocrinology and Diabetes Department, IRCCS, San Raffaele Pisana, 00163 Rome, Italy
Interests: diabetes; metabolism; endocrinology; hypertension; metabolic diseases; blood pressure; atherosclerosis; nutrition; internal medicines; insulin resistance; lipid metabolism; nutraceuticals; medical aerospace
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Special Issue Information

Dear Colleagues,

The most frequent local complications of insulin injection are subcutaneous nodules due to incorrect injection techniques called lipodystrophies (LD). Injection into nodules has a series of negative consequences for glycemic control and variability, the frequency of severe hypoglycemia, the economic burden of diabetes, and the quality of life of patients with diabetes.

Guidelines and expert consensuses on injection techniques have appeared in the literature, and case series, surveys, and clinical trials concerning this topic are published continuously. Nevertheless, unfortunately, LD frequency remains dramatically high, mercilessly decreeing a defeat for healthcare providers. Common misconceptions, prejudices, educational deficiencies, and much more influence the incorrect injection behavior of people with diabetes, and a flawed or, even worse, incorrect approach to the problem by healthcare professionals is also, at least partly, responsible for such neglected insulin treatment complications.

These aspects deserve attention and represent a call to integrated action by educators, clinicians, researchers, and people with diabetes to correctly address a behavioral defect responsible for severe short- and long-term consequences for the latter and enormously increased costs for national health systems worldwide.

The Editorial Board invites you to send your contributions in the form of commentaries, short communications, research papers, clinical trials, case series, or surveys to provide readers with a timely update on insulin-induced lipodystrophies.

Dr. Sandro Gentile
Dr. Felix Strollo
Guest Editors

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Keywords

  • diabetes
  • insulin treatment
  • injection technique
  • skin complications
  • acquired lipodystrophy

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Published Papers (1 paper)

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Research

18 pages, 5033 KiB  
Article
Insulin-Related Skin Lipohypertrophy in Type Two Diabetes: A Clinical Study of a Case Series, with Ultrasonographic and Histopathologic Implications
by Sandro Gentile, Felice Strollo, Giuseppina Guarino, Andrea Ronchi, Ersilia Satta, Teresa Della-Corte, Elisabetta Fulgione, Graziella Babino, Edi Mattera, Emilia Martedì, Roberta Di Martino, Raffaella Fiorentino, Roberta Porcini, Carmine Romano, Maria Chiarello, Giuseppe Caccavale, Renato Franco and Giuseppe Argenziano
Diabetology 2024, 5(7), 725-742; https://doi.org/10.3390/diabetology5070053 - 20 Dec 2024
Viewed by 585
Abstract
Introduction: The most frequent local complication of insulin injection is the occurrence of subcutaneous nodules due to incorrect injection technique. Injection into nodules negatively impacts metabolic compensation and the requirement for greater insulin doses due to its partial and erratic absorption. Despite these [...] Read more.
Introduction: The most frequent local complication of insulin injection is the occurrence of subcutaneous nodules due to incorrect injection technique. Injection into nodules negatively impacts metabolic compensation and the requirement for greater insulin doses due to its partial and erratic absorption. Despite these concepts being accepted by the scientific community, it is not yet clear whether injection into nodules is causally related to worsening chronic diabetes (DM) complications and the morphological nature of such nodules. Aim: This multicenter study aimed to evaluate the associations between structural characteristics of skin nodules and chronic DM complications. A secondary endpoint was to evaluate the histological structure of those nodules, looking for differences between lipohypertrophies (LH) and amyloid nodules (LIDA). Methods: For this purpose, 816 DM patients with LH and 1033 without LH underwent a clinical and ultrasound study comparing metabolic data, injection habits, and frequency of complications. Excisional biopsies of the skin nodules were performed in a small series of eight subjects. Results: Data observed confirm a strong relationship between LH and diabetes chronic complications other than poor glycemic control. Histology of biopsies from the skin nodules showed mild foreign-body-like inflammation, prevailing mega-adipocytes (65%), apoptosis, and fibrosis but could not detect any amyloid fibrils. In four cases, intra-nodular fluid was present with an insulin concentration several times higher than in blood. Conclusions: We confirmed LHs to be significantly associated with insulin administration errors, duration of insulin therapy, greater daily doses and duration of insulin administration, and the presence of micro- and macro-vascular DM complications. LH nodules displayed no typical morphological features and were indistinguishable from LIDA nodules with which they shared several histologic similarities, albeit within the frame of a general picture of LIDA inhomogeneity. Further targeted studies are warranted to clarify the remaining doubts. Full article
(This article belongs to the Special Issue Insulin Injection Techniques and Skin Lipodystrophy)
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