Ultrasonographic aspect of subcutaneous tissue dystrophies as a result of insulin injections

Aims: The aim of the study was to evaluate by ultrasonography the local dystrophies caused by insulin subcutaneous injections. The insulin treated diabetic patients must inject their long life insulin into normal tissue. The objective was to add ultrasonographic arguments to the clinic examination in order to periodically reconsider the available area to be used. Patients and methods: Forty insulin treated patients (14 male, 26 female) were clinically diagnosed with hypertrophic, atrophic, nodular, or inflammatory-like tissue dystrophies as a consequence of injections. These local dystrophies are not always conspicuous, barely suggesting a subdermal pathology. US evaluation, mainly subcutis, was used for assessing them. Results: Besides the clinical signs, ultrasonography offers some distinct appearances: a simple subcutis hypertrophy, a variety of nodular-shaped or diffuse hyperechogenity, subcutis atrophy, complex multilayer changes or possible inflammatory reactions. These abnormal entities have led to erratic insulin absorption and glucose control deterioration, if the patients have continued to inject into the same areas. Conclusions: Ultrasound interrogation should be used as a non-invasive measure for diagnosing insulin injections local dystrophies. Once diagnosed, their future evolution should be observed. By making a real ultrasonographic map of the injected areas a functional insulin treatment could be obtained and preserved.