Insulin injection for diabetes
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Insulin Injection for Diabetes: Techniques, Technologies, and Treatment Outcomes
Introduction to Insulin Injection for Diabetes Management
Insulin injection remains a cornerstone in the management of diabetes, particularly for patients with type 1 diabetes mellitus (T1DM) and those with advanced type 2 diabetes mellitus (T2DM) who do not achieve glycemic control with oral medications alone. Proper injection techniques and advancements in insulin delivery systems are crucial for effective diabetes management and minimizing complications.
Best Practices for Insulin Injection Techniques
Importance of Proper Injection Technique
Proper injection technique is essential to ensure insulin is delivered to the subcutaneous tissue, avoiding intramuscular injections which can lead to unpredictable absorption and complications such as lipohypertrophy. New guidelines emphasize the importance of education on injection techniques, site care, and rotation to prevent these issues 1.
Needle Length and Injection Sites
The use of shorter needles (4-mm pen and 6-mm syringe needles) is recommended as they are effective, less painful, and reduce the risk of intramuscular injections. Proper site rotation is also crucial to prevent lipohypertrophy, which can distort insulin absorption 8.
Insulin Delivery Systems: Pumps vs. Multiple Daily Injections (MDI)
Insulin Pumps for Type 1 Diabetes
Insulin pumps (continuous subcutaneous insulin infusion, CSII) have been shown to improve glycemic control in adults with T1DM when compared to multiple daily injections (MDI). Studies indicate that CSII, combined with continuous glucose monitoring (CGM), results in better time-in-range glucose levels and reduced hyperglycemia, although it may increase the risk of hypoglycemia 26.
Insulin Pumps for Type 2 Diabetes
For patients with poorly controlled T2DM, insulin pumps can also be a valuable treatment option. Research shows that pump therapy can significantly reduce HbA1c levels compared to MDI, with a lower total daily insulin dose and no significant difference in body weight changes 4. Additionally, the use of once-weekly insulin icodec has shown similar efficacy and safety profiles to daily insulin glargine, potentially improving treatment adherence 5.
Continuous Glucose Monitoring (CGM) and Insulin Therapy
CGM in Type 1 and Type 2 Diabetes
CGM has proven beneficial in both T1DM and T2DM patients receiving insulin therapy. In T1DM, CGM combined with CSII improves glycemic control and reduces hyperglycemia 2. In T2DM, CGM use alongside MDI has been shown to improve HbA1c levels, supporting its use as an additional management tool for better glycemic control 3.
Adjunctive Therapies and Insulin
Empagliflozin with Insulin Therapy
Adding empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, to MDI insulin regimens in obese patients with T2DM has demonstrated improved glycemic control, reduced insulin doses, and weight loss without increasing the risk of hypoglycemia 9.
Conclusion
Insulin injection remains a critical component of diabetes management, with advancements in delivery systems and adjunctive therapies enhancing treatment outcomes. Proper injection techniques, the use of insulin pumps, and continuous glucose monitoring are pivotal in achieving optimal glycemic control and minimizing complications in both type 1 and type 2 diabetes.
Sources and full results
Most relevant research papers on this topic
New injection recommendations for patients with diabetes.
New injection guidelines for diabetes patients provide evidence-based guidance for comfortable, effective, and complication-free injections.
Systematic Review
Highly CitedEffect of initiating use of an insulin pump in adults with type 1 diabetes using multiple daily insulin injections and continuous glucose monitoring (DIAMOND): a multicentre, randomised controlled trial.
Switching from multiple daily injections to continuous subcutaneous insulin infusion in adults with type 1 diabetes using continuous glucose monitoring can improve glycemic control and reduce hyperglycemia.
RCTHighly CitedContinuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections: A Randomized Trial.
Continuous glucose monitoring (CGM) improves glycemic control in adults with type 2 diabetes receiving multiple daily insulin injections compared to usual care.
RCT
Rigorous JournalHighly CitedInsulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomised open-label controlled trial
Insulin pump treatment is more effective than multiple daily injections for lowering glucose in type 2 diabetes patients, with no significant difference in bodyweight change.
RCT
Large Human TrialHighly CitedOnce-Weekly Insulin for Type 2 Diabetes without Previous Insulin Treatment.
Once-weekly insulin icodec has glucose-lowering efficacy and a safety profile similar to once-daily insulin glargine U100 in patients with type 2 diabetes without previous insulin treatment.
RCTRigorous JournalHighly CitedA cluster randomised trial, cost-effectiveness analysis and psychosocial evaluation of insulin pump therapy compared with multiple injections during flexible intensive insulin therapy for type 1 diabetes: the REPOSE Trial.
Pump therapy is clinically effective and cost-effective for adults with type 1 diabetes compared to multiple daily injections, with both groups showing improvements in HbA1c and quality of life.
RCTLarge Human TrialAcid-Resistant Mesoporous Metal-Organic Framework toward Oral Insulin Delivery: Protein Encapsulation, Protection, and Release.
The acid-resistant mesoporous metal-organic framework, NU-1000, effectively protects insulin from stomach acid and digestive enzymes, enabling oral insulin delivery for insulin resistant diabetes patients.
Highly CitedEADSG Guidelines: Insulin Therapy in Diabetes
Insulin therapy is essential for patients with type 2 diabetes mellitus (T2DM) and should be considered when HbA1c levels are 7.5% and 10%, respectively.
Rigorous JournalHighly CitedImproved Glucose Control With Weight Loss, Lower Insulin Doses, and No Increased Hypoglycemia With Empagliflozin Added to Titrated Multiple Daily Injections of Insulin in Obese Inadequately Controlled Type 2 Diabetes
Empagliflozin added to multiple daily injections of insulin improves glucose control, weight loss, and lowers insulin doses in obese patients with type 2 diabetes mellitus without increased hypoglycemia.
RCTLarge Human Trial
Very Rigorous JournalHighly CitedInsulin therapy in type 2 diabetes.
Early insulin therapy in type 2 diabetes patients can improve long-term glycemic control and reduce complications, with new insulin analogs enhancing flexibility and reducing injection time.
Systematic Review