Endocrine Abstracts

Introduction: Condition of injected skin and subcutaneous tissue is assessed by visual inspection and palpation and it has only 10–15% diagnostic value. The standard ultrasonography comparison of symmetrical skin areas is not valuable as they are usually used for injections.

Objective: We examined 143 patients, aged 43.3 ± 3.9 years, with DM duration of 6.5 ± 2.8 years, receiving basal-bolus insulin therapy.

Methods: Ultrasonography was performed for 78 volunteers with uninjected skin and subcutaneous tissue of the lumbar and epigastric regions. We determined correction factors that predict skin thickness at the injection site if insulin weren’t administered.

Results: Ratio indices at the injection regions were calculated – the ratio of the dermis thickness of the studied to lumbar region. In the anterolateral shoulder region, normal indices were defined: for epidermis in the range of 0.9–1.0; for dermis – 0.5–0.7. In the anterolateral thigh region: for epidermis – 0.8–1.0; for dermis – 0.5–0.8. In the umbilical region: for epidermis – 0.8–1.0; for dermis – 0.6–0.8. In the upper outer quadrant of the buttock: for epidermis – 0.8–1.0; for dermis – 0.7–0.9. With values decrease, hypotrophic lipoatrophy development is expected. When performing ultrasonography and analyzing the ratios of the epidermis and dermis of the lumbar region to injection sites, changes were detected in every 4 (37 patients), which is 25%. Post-injection hypotrophic lipoatrophy was diagnosed in the umbilical region (49%), in the anterolateral shoulder (24%) and thigh (17%) regions, in the gluteal region (10%).

Conclusion: Using ratio indices during ultrasonography, it is possible to diagnose and treat post-injection lipodystrophies in the earliest time in order to achieve the highest insulin injection bioavailability.