Complications of insulin therapy

Side effects of insulin preparations

Therapy with pancreatic hormone medications is associated with the risk of developing a number of specific adverse events that require constant attention from both the physician and the patient.

• Hypoglycemia. This is the most frequent and potentially most dangerous complication in clinical practice. In severe cases, a rapid drop in glucose levels can progress to a life-threatening hypoglycemic coma. The main triggers are a banal drug overdose, a clear mismatch between the administered dose and the amount of food consumed, or an inadequately high physical load without preliminary carbohydrate compensation.
• Lipodystrophy. This complication manifests as local atrophy or, conversely, hypertrophy of the subcutaneous adipose tissue directly in the areas where the hormone is administered. The main risk factor for such changes is a gross violation of injection technique and ignoring the rule of mandatory rotation (alternation) of injection sites.
• Allergic reactions. The immune system's response to the drug can be either limited local or severe systemic in nature. It is important to remember that the fact of an allergy developing is directly classified as an adverse event. This requires mandatory notification of the Federal Service for Surveillance in Healthcare (Roszdravnadzor), especially during the initial prescription of insulin therapy or when transferring a patient from one drug to another.
• Insulin edema and vision disturbances. Such reactions, including transient refraction disorders, usually manifest against the background of overly rapid drug correction of long-standing chronic hyperglycemia.

Risks when replacing a medicinal product

The process of transferring a patient from one type of insulin to another is a critical period that requires careful monitoring. At this time, a sharp deterioration in overall glycemic control is possible. The patient's baseline hormone requirement may change significantly, which will inevitably necessitate recalculating the usual dosages. Any such adverse events arising from a change in the therapeutic regimen are subject to strict medical reporting and documentation.

Outpatient monitoring regulations

To timely detect complications and adjust treatment, a strict dispensary observation algorithm has been established. Patients must be regularly examined by a specialized expert — a pediatric endocrinologist. The frequency of such visits must be at least once every three months.

At each scheduled outpatient appointment, the physician is required to comprehensively assess the following parameters:

1. The patient's general health status.
2. The level of glycemic control (includes a detailed analysis of glycemic profile indicators and glycated hemoglobin — HbA1c).
3. The degree of adequacy of the current insulin therapy regimen.
4. The rates of physical and sexual development of the child or adolescent.
5. The state of the skin at the administration sites. Visual and palpation examination must be thoroughly performed on standard insulin injection sites (to rule out lipodystrophy), infusion set placement sites (if the patient is on pump therapy), and continuous glucose monitoring (CGM) sensor fixation points.

Structure of the appointment: complaints and anamnesis

In addition to an objective examination, the most important part of the visit is a conversation with the patient. The physician purposefully collects complaints, paying special attention to any symptoms that may indicate the development of diabetes mellitus complications or the addition of concomitant pathology. If alarming signs are detected, additional examination is immediately prescribed.

When collecting the anamnesis of events since the last visit, the following are recorded:

• Intercurrent diseases suffered (e.g., acute respiratory viral infections).
• Episodes of emergency conditions directly related to the course of diabetes mellitus (cases of ketoacidosis or severe hypoglycemia).
• All facts of emergency or planned hospitalizations.

Note: If the patient is consulting this specialist for the first time, the regulations require taking the most complete and detailed anamnesis from the very beginning of the disease.

Class and exam questions

What else to study on this topic

• Pathogenesis of hypoglycemic coma development
• Mechanisms of insulin edema formation
• Algorithm for switching a patient to another insulin preparation
• Rules for rotating injection sites to prevent lipodystrophy
• Features of pump insulin therapy and continuous glucose monitoring

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.