胰岛素注射后脂肪增生与脂肪萎缩资料.pptxVIP

LIPOHYPERTROPHY: the State of the Art;Lypohypertrophy;Seven landmark studies;LH is common;Have you ever noticed swelling of fatty tissue or small bumps at your injection sites? ;What is your experience?;Seven landmark studies;Results: Frequency lipohypertrophy : 48.8% Three independent risk factors : Using insulin for long time (p=0.001), Giving injection in same place (p=0.004), Reusing the same needle (p=0.004). ;Could there be other causes?;Seven landmark studies;How is insulin absorbed in lipohypertrophy?;Seven landmark studies;Diabetes Care 2005; 28:2025-2027;Continuous glucose monitoring system;Injection in lipohypertropy Average= 220 mg/dl; SD = 66 Insulin = 33 U/day;Injection in healthy area Average= 155 mg/dl; SD = 47 Insulin = 28 U/day;Do you think of lipohypertrophy in patients with unstable glucose?;Seven landmark studies;2;2011: 80-83.;Patient case;Case Patient Outcome Data;Case Patient Outcome Data;Case Patient Outcome Data;What are clues lipohypertrophy might be present?;Seven landmark studies;Franzen I, J. Ludvigsson, Link?ping 1997 Specific Instructions Gave Reduction of Lipomas and Improved Metabolic Control in Diabetic Children, Diabetologia Vol 40, Supplement 1: A615 (1997); ;Results;Cost of TherapyPatient A;Daily Insulin Dose and Cost of TherapyPatient B;Daily Insulin Dose and Cost of TherapyPatient C;Do any studies answer the cost question?;Seven landmark studies;Patients;;Prevalence of LH;Lipohypertrophy and Observed Correct Rotation: Actual Results;Lipohypertrophy and Observed Correct Rotation : hypothetical results if there were a perfect causative relationship;Hypoglycemia;Hypoglycemia;Glucose Variability;Glucose Variability;LH and Total Insulin Dose;Health Economic Costs;Learnings about LH;;But won’t this increase the risk of IM injections?;7 mm;All needles are at least twice as long as the skin is thick;Needle length and IM injections;If a Patient is giving 3 injections a day, how often would he inject