Lower risk of glycaemic variation
Impact of glycaemic variation
Investigators Blanco et al. 1, diabetes Specialist Nurses in Spain, noticed that a number of patients frequently presented to clinic with recurring unexplained hypoglycaemia and glycaemic variation. 'They observed' a correlation between the presence of glycaemic variation and hypoglycaemia and the presence of lipohypertrophy.
They found in their study that1:
Clinical Case Study cited in Blanco 20131
Clinical base-line characteristics and medical history:
- 32 year old male
- 18 year history of T1Diabetes
- Basal bolus insulin therapy - Glargine and Lispro Total Daily Dose (TDD) 136 units
- Levetiracetam (treatment for epilepsy)
- 12.7mm needle with reuse >10x
- HbA1c 6.9%
- Referred to neurology department May 2011with history of
- Severe nocturnal hypoglycaemia
- Tonic-clonic seizures since August 2010
- Multiple emergency service call outs to his home because of seizures – severe hypo noted at time of seizure requiring Glucagon IM injections
- Brain magnetic resonance imaging (MRI) and electroencephalogram (EEG) all negative
- Referred to Diabetes Unit in one of the study sites August 2012 – review showed:
- Palpable lipohypertrophy lesions detected both sides of abdomen
- Self-reported always injects into same lipohyperthrophy lesions
Clinical Lipohypertrophy
‘Echo-signature’ of Lipohypertrophy
Outcome after optimal injection technique intervention:
- Switched to 5mm pen needles (shortest available needle at the time) to minimise intramuscular risk
- ‘Single needle use only’ instruction reinforced
- Educated to use correct injection technique including correct rotation and to avoid injecting into lipohypertrophy lesions
- Insulin dose reduced as a precaution against potential hypoglycaemia
Longer term follow up review and outcome:
- Follow up December 2012
- Self-reported
- No seizures since August 2012
- No emergency service call out since August 2012
- No nocturnal hypoglycaemia since August 2012
- Levetiracetam discontinued
- Subsequent reports of 2-3 day time hypoglycaemia per week
- Insulin dose further reduced
- Total Daily Dose 48 units at most recent clinical review prior to publication of paper
- Total Daily Dose of insulin reduced by 88 units compared to 136 units 5 months earlier
- HbA1C remained 6.9%
References
- 1 Blanco M, et al. Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes. Diabetes Metab (2013)