Background: Insulin therapy by creating a subcutaneous depot remains an integral part of the treatment of diabetes in children. Places of insulin administration are restricted to certain parts of the body and the condition of subcutaneous fat affects the variability of glycaemia no less than quality of insulin. Formation of lipodystrophies (LD) causes glycaemia variability, difficulties in selection of insulin doses and achieving disease compensation.
Objective and hypotheses: The use of ultrasonic method for studying injection sites for early detection of presence and form of LD. A working hypothesis about the possibility of identifying the nature of LD by an ultrasound (US) investigation of subcutaneous fat has been considered in the study.
Method: We have investigated the hypothesis about the possibility of identifying the nature of the LD by ultrasound investigation (US) of subcutaneous fat. In order to confirm it 108 children 6 -16 years old have been surveyed, patients with type 1 diabetes treated with insulin from 6 months to 12 years.
Results: In 74 children (68.5%) pathological changes of injection sites were verified by ultrasound investigation of subcutaneous fat. Muscular form of LD, which is manifested by clinically atrophic areas on the thighs, has been revealed in 2 (3%) subjects. 45 (60.5%) patients have a diffuse form of LD, 17 subjects (23%) its focal form, and 10 children (12.5%) have a mixed form of LD. In the structure of focal and mixed forms of LD has been singled out LD with a heterogeneous echostructure with predominance of hyperechogenic inclusions. Such patients do not change needles often enough (every 4.5 days on an average). The muscular form is difficult to treat and does not disappear after the change of injection site.
Conclusion: Hyperechoic areas in the subcutaneous fat may serve as an early marker of LD and develop due to multiple injuries in violation of insulin therapy technique.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology