Hypoglycemia is the most common and most serious complication of insulin therapy. Hypoglycemia can be potentially life-threatening. Most patients who use insulin experience hypoglycemia at one time or another. If a patient injects too much insulin blood glucose level can fall low enough to cause hypoglycemia. The body reacts to hypoglycemia with increased plasma dopamine, epinephrine, and plasma renin activity.
Some drugs that may interact with insulin:
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Insulin allergy is a very rare occurrence because todays biosynthetic human insulins are identical to endogenous insulins, and pork insulins vary from human insulin by only one amino acid. That one difference can induce immune response antibodies that may reduced efficacy when used as long-term therapy. The immune response can also produce injection site hypersensitivity reactions which can include erythema, swelling, heat, or subcutaneous nodules. or biosynthetic human insulin. True insulin allergy can be treated by desensitization.
Lipoatrophy at insulin injection sites is becoming a rare complication of insulin therapy. Human insulin preparations have reduced lipoatropy prevalence to about 3.6%. The precise pathogenesis remains unclear, but possible mechanisms include immune reaction to insulin or excipients of the injection solution, injury from cold insulin, or trauma from repeated local injections. Lopez, Velazquez, Castells et al. examined subcutaneous biopsies in acute and chronic insulin injection sites. They found atrophy of lobular adipose tissue and variable extent of angiocentric and lobular lymphocytic infiltrate. Focal fibrosis was present in all chronic injection sites.
Chronic use of the same injection site increases the risk of lipoatrophy. Patients learn that these areas become relatively pain free and continue to use them. The fibrotic changes that occur at lipotrophic sites is believed to affect insulin absorption from lipoatrophic areas can result in difficulties in achieving ideal blood glucose control.
Lipohypertrophy is a subcutaneous complication of the injection of insulin. Insulin can cause hypertrophy of adipose cells, that appear as a smooth rounded lump. While newer insulins have reduced the prevalence of lipohypertrophy, it is common and can adversely affect diabetic control by causing the erratic release of insulin into the systemic circulation. Lipohypertophy gradually recedes if the area is avoided.
Safe and effective insulin therapy requires patient adherence to specific preparation, and injection routines. Patient education should include product-specific storage, injection technique, accurate dosages, and site rotation.
References
Lopez X, Castells M, Ricker A, Velazquez EF, Mun E, Goldfine AB. Human insulin analog--induced lipoatrophy. Diabetes Care. 2008 Mar;31(3):442-4.
The American Diabetes Association's Clinical Diabetes series is an important and rich source of clinical information that every nurse should be familiar with.
For example, visit the Clinical Diabetes web site and search "air travel".
Select the:
Manju Chandran and Steven V. Edelman
Have Insulin, Will Fly: Diabetes Management During Air Travel and Time Zone Adjustment Strategies
Clinical Diabetes April 2003 21:82-85; doi:10.2337/diaclin.21.2.82
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