Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr;12(4):1143-1157.
doi: 10.1007/s13300-021-01026-w. Epub 2021 Mar 9.

Bruising: A Neglected, Though Patient-Relevant Complication of Insulin Injections Coming to Light from a Real-Life Nationwide Survey

Sandro Gentile  1   2 , Giuseppina Guarino  3   4 , Teresa Della Corte  3   4 , Giampiero Marino  3   4 , Ersilia Satta  4 , Carmine Romano  4 , Carmelo Alfrone  4 , Clelia Lmberti  4 , Felice Strollo  5 ; AMD-OSDI Study Group
Collaborators, Affiliations

Bruising: A Neglected, Though Patient-Relevant Complication of Insulin Injections Coming to Light from a Real-Life Nationwide Survey

Sandro Gentile et al. Diabetes Ther. 2021 Apr.

Abstract

Introduction: Despite the availability of sophisticated devices and suitable recommendations on how to best perform insulin injections, lipohypertrophy (LH) and bruising (BR) frequently occur as a consequence of improper injection technique.

Aim: The purpose of this nationwide survey was to check literature-reported LH risk factors or consequences for any association with BR METHOD: This was a cross-sectional, observational, multicenter study based on the identification of skin lesions at all patient-reported insulin injection sites in 790 subjects with diabetes. General and injection habit-related elements were investigated as possible BR risk factors.

Results: While confirming the close relationship existing between LH and a full series of factors including missed injection site rotation, needle reuse, long-standing insulin treatment, frequent hypoglycemic events (hypos), and great glycemic variability (GV), the observed data could find no such association with BR, which anyhow came with high HbA1c levels, missed injection site rotation, and long-standing insulin treatment.

Conclusion: BR most likely depends on the patient's habit of pressing the injection pen hard onto the skin. Despite being worrisome and affecting quality of life, BR seems to represent a preliminary stage of LH but does not affect the rate of hypos and GV.

Trial registration: 207/19.09.2017.

Keywords: Bruising; Diabetes; Injection technique; Insulin; Lipohypertophy.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Absolute frequency of subjects using needles of different length (a) and gauge (b). NK not known
Fig. 2
Fig. 2
Insulin injection-induced bruising in two subjects: in the abdominal wall on the left and on the arm in the right panel
Fig. 3
Fig. 3
Bruising at the injection site (a, b). Lateral view of a LH nodule coming together with bruising (c), best seen after magnification (d)
Fig. 4
Fig. 4
Panel a shows stronger pen pressure into the skin (deep skin hollow) at the time of injection than in b. c Arrow highlights the needle cone which—if pressed too hard—can cause trauma to the skin
See this image and copyright information in PMC

References

    1. Stocki K, Ory C, Vanderplas A, et al. An evaluation of patient preference for an alternative insulin delivery system compared to standard vial and syringe. Curr Med Res Opin. 2007;23:133–146. doi: 10.1185/030079906X159524. - DOI - PubMed
    1. Rosak C, Burkard G, Hoffmann JA, et al. Metabolic effect and acceptance of an insulin pen treatment in 20,262 diabetic patients. Diab Nutr Metab. 1993;6:139–145.
    1. Hansen B, Matytsina I. Insulin administration: selecting the appropriate needle and individualizing the injection technique. Expert Opin Drug Deliv. 2011;8(10):1395–1406. doi: 10.1517/17425247.2011.614229. - DOI - PubMed
    1. Frid AH, Hirsch LJ, Menchior AR, Morel DR, Strauss KW. Worldwide injection technique questionnaire study: injecting complications and the role of the professional. Mayo Clin Proc. 2016;91(9):1224–1230. doi: 10.1016/j.mayocp.2016.06.012. - DOI - PubMed
    1. Gentile S, Grassi G, Armentano V, et al. AMD-OSDI consensus on injection techniques for people with diabetes mellitus. Med Clin Rev. 2016;2:3. http://medical-clinical-reviews.imedpub.com/archive.php. Accessed 20 Feb 2021.

LinkOut - more resources