RU2438585C1 - Method of insulin injection point determination - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, particularly to endocrinology, and is intended for determination of insulin injection points for diabetes patients. Ultrasonic scanning of standard areas is performed with sensor frequency of 7.5 MHz or higher. Areas where none of formations, such as capsules, hyperechoic, homogeneous and avascular formations are detected are determined as acceptable for insulin injection. ^ EFFECT: enhanced reliability of determination of insulin injection points for diabetes patients undergoing insulin therapy. ^ 2 ex

Description

The invention relates to medicine, namely to the field of endocrinology, and can be used to determine the injection sites of insulin in patients with diabetes mellitus and undergoing insulin therapy.

Currently, according to the International Diabetes Federation (IDF), more than 200 million people suffer from diabetes, and by 2025 the number of patients will be more than 380 million. In the overall structure of the disease, 85-90% are type 2 diabetes mellitus (DM 2) and 10-15% for type 1 diabetes mellitus (DM 1), which is associated with absolute insulin deficiency (Dedov I.I. New opportunities for the treatment of type 2 diabetes // Journal of Diabetes // special issue 2009, p. one). The only way to treat diabetes 1 is insulin therapy, and insulin is administered 4-5 times a day. According to the latest recommendations from leading diabetes organizations in the world, patients with type 2 diabetes need early insulin treatment, at least in the basal regimen (American Diabetes Association. Standards of Medical Care in Diabetes-2008, Diabetes Care website,

http://care.diabetesjournals.org/content/31/Supplement_1/S12.full?sid=70825077-869a-47f2-9138-393bb7fa72f5). Thus, patients with diabetes who need constant insulin therapy, a large number and their number will only increase.

Insulin therapy is carried out in typical areas on the human body that are used for injection: the outer surface of the shoulders, the front surface of the abdomen, the front surface of the thighs, buttocks. Against the background of insulin therapy, patients very often develop changes in subcutaneous fat, the so-called lipodystrophy, which manifests itself at the injection site of insulin in the form of atrophy, or hypertrophy, a hypertrophic form, subcutaneous fat. It is also known that insulin transport is disturbed from the changed sites, and as a result, it is impossible to achieve compensation for carbohydrate metabolism. The lack of compensation, in turn, leads to the development of more formidable complications of diabetes, such as diabetic retinopathy, nephropathy, polyneuropathy. In this connection, the importance of determining the injection sites is beyond doubt. The complexity of their determination lies in the fact that the external manifestations associated with the development of lipodystrophy have undergone significant changes and are almost invisible to the naked eye due to the higher quality of modern insulins (Starostina E.G. Insulin and insulin therapy: “dark forest” or a harmonious system ? // The journal “In the world of drugs” // No. 2, 1998. http://medi.ru/doc/7280212.htm).

Studies on the medical, scientific and patent literature have revealed various methods for determining the injection sites of insulin.

In the textbook, Multivolume Guide to Internal Medicine, Volume VII / Edited by Barinov V.G. L .: “Medicine”, 1966, p. 311 describes a method for determining places suitable for insulin injections, which is based on a visual assessment of typical injection zones on the human body. The criterion for determining the locations permitted for insulin injections is the absence of elevations and depressions in typical injection zones. The disadvantage of this method is the lack of reliability due to the use of modern insulin, which does not cause pronounced changes: elevations and depressions in the subcutaneous fat.

In the work of Dedov I.I. Insulin therapy, a guide for doctors. Moscow, 2004, http://www.voed.ru/insulinotherapy.htm, a method for determining the sites of insulin injections is described, which consists in conducting a biopsy of the sites with suspected presence of lipodystrophy. The disadvantage of this method is that it is invasive and highly costly. The high cost is associated with the involvement of several specialists in the study, such as a doctor taking the material, a morphologist.

The closest technical solution we have taken as a prototype is the method for determining the zones of insulin injection described in Endocrinology. V.V. Potemkina. M., "Medicine", 1978, p. 266. The method involves the study on the human body of the typical areas used for injection of insulin using the palpation method. In the absence of seals in typical areas of insulin injection, these sites are defined as allowed for injection.

The disadvantage of the prototype is its lack of reliability, associated with the possibility of lack of seals of subcutaneous fat in typical areas of insulin injection, which makes it difficult to determine the places where you can enter insulin, and where not.

The aim of the invention is to increase the reliability of determining the injection sites of insulin in patients with diabetes who are on insulin therapy.

This goal is achieved by the fact that typical injection zones are examined on the patient’s body. The study of typical areas is performed by ultrasound with a sensor frequency of at least 7.5 MHz. Areas of zones with the simultaneous absence of all formations: without capsule, hyperechoic, homogeneous and avascular, are defined as places allowed for insulin injections.

Detailed description of the method.

An insulin-treated patient with diabetes mellitus undergoes an ultrasound scan of typical areas for insulin injection.

The study is carried out using, for example, a universal ultrasonic scanning device (Caris Plus) (TU 9442-001-07509215-2004) manufactured by Ural Instrument Making Plant using a linear sensor with a frequency of 7.5 MHz. The study is carried out through a standard ultrasonic gel. The front surface of the abdomen, the outer surface of the shoulders, the front surface of the thighs of the patient is examined in the supine position. Buttocks examined in an upright position or lying on his stomach. On the monitor screen, the structure of subcutaneous fat in typical areas for insulin injection is evaluated. The areas of zones with the simultaneous absence of all formations: without capsule, hyperechoic, homogeneous and avascular, are defined as places allowed for insulin injections.

According to the results of the examination, the patient is issued a conclusion that describes and depicts the places allowed for insulin injections.

The practical feasibility of the proposed method is confirmed by examples from clinical practice:

Example 1

Patient K., 32 years old, medical history No. 1125/183, turned to the Rostov-on-Don City Endocrinology Center on the basis of the City Hospital No. 4 MLPUZ with complaints of thirst, dry mouth, frequent urination, increased blood glucose to 12 mmol / l, frequent hypoglycemia. Diagnosis: Type 1 diabetes mellitus, II severity. From the anamnesis it is known that the patient suffers from diabetes for 5 years, and is on insulin therapy in a basic bolus mode. Glycosylated hemoglobin - 8.0%, which indicated the decompensation of diabetes.

To determine the places allowed for insulin injections, the patient was examined typical injection zones, according to the claimed method. The patient was examined on a Universal Ultrasound Scanning Device (Caris Plus) (TU 9442-001-07509215-2004), manufactured by Ural Instrument-Making Plant, using a linear sensor with a frequency of 7.5 MHz, through a standard ultrasonic gel. Typical areas for insulin injection were investigated: the abdominal wall, the outer surface of the shoulders, the front surface of the thighs of the patient was examined in the supine position. The buttocks were examined lying on the stomach. On the monitor screen, the structure of subcutaneous fat in typical areas for insulin injection was evaluated. It was revealed: on the outer surface of the shoulders, all formations were simultaneously absent: without a capsule, hyperechoic, homogeneous, and avascular, this zone was defined as allowed for insulin injections. At the same time, all formations were absent on the front surface of the thighs: without a capsule, hyperechoic, homogeneous, and avascular; this area was defined as being allowed for insulin injections. At the same time, all formations were absent on the buttocks: without a capsule, hyperechoic, homogeneous, and avascular, this zone was defined as allowed for insulin injections. On the anterior abdominal wall subcutaneously at a distance of 4 cm from the navel for 3 hours a hyperechoic, homogeneous, rounded formation of 3 × 4 cm without capsule and avascular is located; in the rest of the zone, all formations were simultaneously absent: without a capsule, hyperechoic, homogeneous and avascular, this part of the zone has been identified as being approved for insulin injection. A conversation was held with the patient and the locations permitted for insulin injections were indicated. Upon further observation, the patient was compensated for diabetes mellitus, since, following the recommendations, he injected insulin in exactly those places that were recommended to him after the study.

Example 2

Patient A., 39 years old, medical history No. 1167/194, turned to the Rostov-on-Don City Endocrinology Center on the basis of the City Hospital No. 4 MLPUZ with complaints of thirst, dry mouth, frequent urination, increased blood glucose to 10 mmol / l. Diagnosis: Type 1 diabetes mellitus, II severity. From the anamnesis it is known that the patient suffers from diabetes for 3 years, and is on insulin therapy in a basic bolus mode. Glycosylated hemoglobin - 7.7%, which indicated the decompensation of diabetes mellitus.

To determine the places allowed for insulin injections, the patient was a study of typical areas for injection, according to the claimed method. The patient was examined on a universal ultrasound scanning device (Caris Plus) (TU 9442-001-07509215-2004), manufactured by Ural Instrument-Making Plant, using a linear sensor with a frequency of 7.5 MHz, through a standard ultrasonic gel. Typical areas for insulin injection were investigated: the abdominal wall, the outer surface of the shoulders, the front surface of the thighs of the patient was examined in the supine position. The buttocks were examined lying on the stomach. On the monitor screen, the structure of subcutaneous fat in typical areas for insulin injection was evaluated. It was revealed: on the outer surface of the shoulders: on the outer surface of the shoulders, subcutaneously in the middle third of the right shoulder, a round formation without capsule, hyperechoic, homogeneous, avascular 1.0 × 0.7 cm, subcutaneous in the middle third of the left shoulder formation without capsule, hyperegenic, homogeneous , avascular from 0.4 to 1.0 cm in diameter, in the rest of the zone all formations were simultaneously absent: without capsule, hyperechoic, homogeneous and avascular, this part of the zone was defined as allowed for insulin injection. At the same time, all formations were absent on the front surface of the thighs: without a capsule, hyperechoic, homogeneous, and avascular; this area was defined as being allowed for insulin injections. At the same time, all formations were absent on the buttocks: without a capsule, hyperechoic, homogeneous, and avascular, this zone was defined as allowed for insulin injections. At the same time, all formations were absent on the anterior abdominal wall: without a capsule, hyperechoic, homogeneous, and avascular; this area was determined to be allowed for insulin injections. A conversation was held with the patient, and the places allowed for insulin injections were indicated. Upon further observation, the patient was compensated for diabetes mellitus, since, following the recommendations, she injected insulin in exactly those places that were recommended to her after the study.

According to the claimed method, in the Rostov-on-Don city endocrinological center on the basis of MLPUZ "City Hospital No. 4" we examined 50 patients with type 1 diabetes who are on insulin therapy. The duration of the disease is from 3 months to 27 years, the age of patients is from 20 to 53 years, of which 32% are female and 68% are male. The results of the examination, according to the prototype: in 42 patients, all areas were found to be suitable for injection, only in 8 patients there were restrictions on the places of reference. These 42 patients underwent a study according to the claimed method: only 9 patients were recommended for all insulin injections. A conversation was held with the patients and the locations allowed for insulin injections were indicated. Conclusions were issued with marked areas where injection is recommended. In patients who followed the recommendations and injected insulin only into the areas indicated in the recommendations, diabetes mellitus was compensated and the dosage of insulin was reduced in 23%.

Thus, in comparison with the prototype, the proposed method can significantly increase the reliability of determining the injection sites of insulin in patients with diabetes who are on insulin therapy.

Claims (1)

A method for determining insulin injection sites, comprising examining typical injection zones on the patient’s body, characterized in that they perform ultrasound examination of typical zones with an ultrasound method with a sensor frequency of at least 7.5 MHz, and sections of the zones with the simultaneous absence of all formations: without capsule, hyperechoic homogeneous and avascular are defined as places allowed for insulin injections.