2018 Volume 61 Issue 3 Pages 117-125
It has been reported that, in some patients, diabetes treatments with subcutaneous injections induce "non-palpable subcutaneous changes", which are detected only under ultrasound examinations as subcutaneous adipose tissue changes without showing any subcutaneous induration during inspection and palpation. In this study, we examined the influence of the non-palpable or palpable subcutaneous changes induced by such injections on the glycemic control. Changes in subcutaneous adipose tissue were identified on ultrasonography in 15 patients, but no induration was apparent on inspection or palpation in 6 of these patients (40 %). Continuous glucose monitoring showed markedly high postprandial glucose levels not only in patients with palpable induration but also in those with non-palpable subcutaneous changes. We also reported a case of type 1 diabetes with recurrent hypoglycemia and sustained high HbA1c levels. In this case, non-palpable subcutaneous changes were observed widely in the abdomen. By avoiding injections inducing non-palpable subcutaneous, the amount of insulin required was reduced, with a low frequency of hypoglycemia. These findings suggest that we should examine subcutaneous changes by ultrasonography in addition to inspection and palpation in cases of unexpected hyperglycemia or hypoglycemia following insulin treatment. Avoiding injections after detecting subcutaneous changes may therefore be useful for improving the glycemic control in diabetic patients.
