2018 Volume 67 Issue 4 Pages 462-468
Insulin delivery into the subcutaneous tissue depends on the use of the correct technique for insulin self-injection. Subcutaneous induration caused by an incorrect injection technique can lead to changes in insulin absorption, adversely affecting glycemic control. Subcutaneous tissue abnormalities, such as subcutaneous hemorrhage and induration, are frequently detected by inspection and palpation, whereas ultrasonography (US) is only rarely performed. In this study, we assessed by US the skin and subcutaneous tissue of patients receiving insulin therapy to identify trends in US findings and to determine whether US could be used for the assessment of insulin injection techniques. Using US, we assessed the skin and subcutaneous tissue of 35 patients receiving insulin therapy between November 2013 and December 2016. The US findings of injection sites showing palpable induration or skin discoloration were as follows. The cutaneous layer was significantly thicker at the injection sites than on the contralateral side. The cutaneous layer and subcutaneous fat layer at the injection sites were significantly hypoechoic. The border between the cutaneous layer and the subcutaneous fat layer was unclear or the structure of the subcutaneous fat layer was absent. US allows a more efficient observation of a wide area and a more objective assessment than conventional inspection and palpation because US enables the visual detection of changes in the skin and subcutaneous tissue. Furthermore, the use of US to educate patients regarding the correct injection technique and rotation of injection sites can contribute to improved glycemic control.
