Insu
liner
och
inje
ktio
nste
knik
, hu
r svå
rt k
an d
et v
ara?
Eller:Ingentingvarb
ättreförrnärd
etgällerd
iabe
tes.
Ande
rsFridÖrebrono
vembe
r201
9
Insu
lin d
etem
ir, s
can
d im
inje
ctio
nIns
ulin D
etemi
rMe
an P
rofile
s per
Adm
. Rou
teIn
sulin
Det
emir
(pm
ol/l)
e.g.
at t
ime
point
s lat
er th
an 2
40 m
inute
s for
the
i.v. a
dm. r
oute
ther
e is
one
or n
o va
lid m
easu
rem
ents
no m
arkin
gs o
ccur
on
the
figur
ea
mea
n co
ncen
tratio
n of
Insu
lin D
etem
ir. T
hus a
t tim
e po
ints w
here
Note
that
at le
ast t
wo m
easu
rem
ents
mus
t be
avail
able
to ca
lculat
eEa
ch m
ean
prof
ile b
ased
on
data
from
16
subje
ctsTr
ial ID
.: NN
304-
1320
Spad
ille A
pS (0
8FEB
02)
i.m.
i.v.
s.c.
0
500
1000
1500
2000
2500
3000
3500
4000
Elap
sed
Tim
e (h
ours
)0
36
912
1518
2124
Nov
o N
ordi
sk d
ata
on fi
le
Bild
från
inje
ktio
nsbr
osch
yr, N
ovo
1984
Bros
chyr
av
Nov
o om
inje
ktio
nste
knik
från
198
5
The
Palm
er In
ject
or 1
955-
1970
Cou
rtesy
Deb
bie
Hic
ks, L
ondo
n, U
K
Hel
inos
1954
-19
86
Hel
inos
195
4 -1
986
Nov
oPen
1985
Nov
o Fi
ne 8
mm
199
1
Bild
från
inje
ktio
nsbr
osch
yr, N
ovo
1984
CT
of th
igh,
nor
mal
-wei
ght a
dult
mal
e
CT
scan
of a
bdom
en, n
orm
al-w
eigh
t mal
e.
Whi
te d
ots
are
cont
rast
. 8 m
m n
eedl
e.
FITTER
RomeOctob
er20
15
Fitter
Attend
ees
(54coun
tries)
NB.
Additio
nalone
sin
ME,NAfricaandAsia
FITTER
Recommen
datio
nsadop
ted
into
LocalInsulinDe
liveryGu
idelines
(NB.
AllEurop
eandME,muchof
Asiaand
northe
rnS.Am
erica)
Publ
icer
ad 3
mar
s 20
18
Abs
orpt
ion
av d
irekt
verk
ande
in
sulin
anal
oger
•In
gen
skill
nad
i abs
orpt
ions
hast
ighe
t mel
lan
buk
och
lår.
•N
ågot
läng
re v
erka
n fr
ån lå
r.
Abso
rptio
n of
regu
lar i
nsul
in a
nd in
sulin
lis
pro2
Mea
n G
IR v
ersu
s tim
e of
all
treat
men
ts (n
= 1
2): R
egul
ar
insu
lin (0
.2 U
/kg;
A, i
nsul
in li
spro
(0.2
U/k
g; B
).
Braa
k EW
, et a
l. Diab
etes
Car
e.19
96;19
(12)
:1437
-144
0.
Abs
orpt
ion
av d
irekt
verk
ande
in
sulin
anal
oger
•In
gen
skill
nad
i abs
orpt
ions
hast
ighe
t mel
lan
buk
och
lår.
•N
ågot
läng
re v
erka
n fr
ån lå
r.
Abs
orpt
ion
av d
irekt
verk
ande
in
sulin
anal
oger
•In
gen
skill
nad
i abs
orpt
ions
hast
ighe
t mel
lan
buk
och
lår.
•N
ågot
läng
re v
erka
n fr
ån lå
r.•
Inge
n sk
illna
d i a
bsor
ptio
nsha
stig
het m
ella
n fe
tt o
ch
mus
kel,
bara
stu
dera
t i v
ila.
Abs
orpt
ion
av lå
ngve
rkan
de
insu
linan
alog
er•
Små
skill
nade
r i a
bsor
ptio
n m
ella
n lå
r och
buk
(någ
ot
lång
sam
mar
e fr
ån b
uk fö
r gla
rgin
)•
Stor
ski
llnad
i ab
sorp
tions
hast
ighe
t mel
lan
fett
och
m
uske
l.
Insu
lin d
etem
ir, s
c an
d im
inje
ctio
nIns
ulin D
etemi
rMe
an P
rofile
s per
Adm
. Rou
teIn
sulin
Det
emir
(pm
ol/l)
e.g.
at t
ime
point
s lat
er th
an 2
40 m
inute
s for
the
i.v. a
dm. r
oute
ther
e is
one
or n
o va
lid m
easu
rem
ents
no m
arkin
gs o
ccur
on
the
figur
ea
mea
n co
ncen
tratio
n of
Insu
lin D
etem
ir. T
hus a
t tim
e po
ints w
here
Note
that
at le
ast t
wo m
easu
rem
ents
mus
t be
avail
able
to ca
lculat
eEa
ch m
ean
prof
ile b
ased
on
data
from
16
subje
ctsTr
ial ID
.: NN
304-
1320
Spad
ille A
pS (0
8FEB
02)
i.m.
i.v.
s.c.
0
500
1000
1500
2000
2500
3000
3500
4000
Elap
sed
Tim
e (h
ours
)0
36
912
1518
2124
Nov
o N
ordi
sk d
ata
on fi
le
Abs
orpt
ion
av H
uman
insu
liner
•Sn
abba
re a
bsor
ptio
n fr
ån m
uske
l jäm
fört
fett
.•
Snab
bare
abs
orpt
ion
från
buk
jäm
fört
lår.
Inje
ktio
nsdj
up h
ar s
anno
likt i
ngen
be
tyde
lse
(två
stu
dier
)
Inje
ctio
n D
epth
and
Insu
lin A
bsor
ptio
n
•12
5 I-la
belle
d sh
ort a
ctin
g in
sulin
was
inje
cted
( 5
units
eac
h pa
tient
)•
Rad
ioac
tivity
dec
reas
ed b
y in
sulin
ab
sorp
tion
(in %
)•
One
def
ined
inje
ctio
n si
te w
as c
hose
n fo
r eac
h ab
omen
and
thig
h•
2 in
ject
ion
dept
hs, c
ontro
lled
by
ultra
soun
d:A)
3mm
bel
ow th
e sk
in s
urfa
ceB)
2mm
abo
ve th
e m
uscl
e fa
cies
Frid
etal.,Intraregiona
lDifferen
cesin
theAb
sorptio
nof
Unm
odified
Insulin
from
theAb
dominalWall_Diab
eticMed
icine19
92;9
;236
239
InjectionDe
pthB)
[from
skinsurfa
ceinmm]:
Abdo
men
92/
153
Thigh
71/
143
A)
B)
3mm
2mm
Inje
ctio
n D
epth
and
Insu
lin A
bsor
ptio
n
No
influ
ence
of t
he in
ject
ion
dept
h on
the
kine
tics
of in
sulin
abs
orpt
ion
has
been
sho
wn
in th
e st
udy.
405060708090100
60 m
in12
0 m
in17
5 m
in
Thig
h - D
eep
Inje
ctio
nTh
igh
- Sup
erfic
ial I
njec
tion
Abdo
men
- D
eep
Inje
ctio
nAb
dom
en -
Supe
rfic
ial I
njec
tion
JDiabe
tesS
ciTechno
l.2015
Jul;9(4):8
2430
Insu
liner
med
kon
cent
ratio
n >
100
E/m
L
•Gla
rgin
(Tou
jeo)
300
E/m
L•D
eglu
dec
(Tre
siba
) 200
E/m
L•L
ispr
o(H
umal
og) 2
00 E
/mL
Deg
lude
c10
0 vs
200
E/m
L
Insu
lin li
spro
(Hum
alog
)
FITTER
isascientificcongress
spon
soredby
Nee
dle
reus
e
FITTER
isascientificcongress
spon
soredby
Reu
se P
erce
ntag
es b
y C
ount
ry (1
)Co
untry
Yes
No
USA
18.4
81.6
Canada
38.7
61.3
Russia
90.3
9.7
SouthAfrica
96.7
3.3
Nethe
rland
s18
.581
.5
Belgium
86.7
13.3
France
20.1
79.9
Spain
37.7
62.3
Italy
15.5
84.5
Switzerland
52.7
47.3
Austria
71.9
28.1
UK
26.1
73.9
Sverige
49.0
51.0
REUSE
FITTER
isascientificcongress
spon
soredby
Res
ults
2tim
es35tim
es610
times
>10tim
es
Nurse
Reported
31.2
41.0
15.4
12.4
PatientReported
30.7
39.7
16.0
13.6
Sverige
1245
1231
FITTER
isascientificcongress
spon
soredby
Why
do
they
reus
e th
e pe
n ne
edle
s?
42
Reason
s%
Sver
ige
BecauseIdidno
thaveanothe
rpen
need
leavailable
9.2
2
Tosave
mon
ey23
.32
Toprevente
xcesswaste
(enviro
nmen
tal
concern)
6.8
4
Forcon
venien
ce41
.278
FITTER
isascientificcongress
spon
soredby
How
ofte
n do
es th
e nu
rse
or
doct
or e
xam
ine
inje
ctio
n si
tes?
43
Freq
uency
%
Routinelyeveryvisit.
28.3
Onceayear
12.6
OnlyifIcom
plainof
aprob
lem
atasite
20.2
Ican’tremem
berm
ysites
ever
beingchecked
38.9
FITTER
isascientificcongress
spon
soredby
Lipo
Perc
enta
ges
by C
ount
ry (1
)Co
untry
YES
NO
Num
ber
USA
6.9
93.1
304
Canada
28.8
71.2
281
Russia
24.0
76.0
104
SouthAfrica
34.8
65.2
155
Nethe
rland
s40
.859
.276
Belgium
33.1
66.9
136
France
36.2
63.8
224
Spain
60.2
39.8
196
Italy
39.4
60.6
310
Switzerland
29.1
70.9
55
Austria
28.4
71.6
95
Argentina
65.3
34.7
72
Swed
en56
.443
.610
144
6en
kla
råd
om in
sulin
inje
ktio
ner
•Det
finn
s in
ga m
edic
insk
a sk
äl a
tt a
nvän
da lä
ngre
nål
än
4 m
m•I
njic
era
aldr
ig i
mus
kel.
•Mod
erna
insu
linan
alog
er ta
s up
p i s
tort
set
t lik
a fr
ån fe
ttvä
ven
på
alla
inje
ktio
nsst
älle
n.•N
PH-i
nsul
in o
ch m
ixin
sulin
erge
s he
lst i
buk
en p
å m
orgo
nen
och
bake
n/lå
ret p
å kv
älle
n.•N
ytt s
tälle
var
je g
ång.
Reg
elbu
nden
und
ersö
knin
g av
in
jekt
ions
stäl
len.
•Anv
änd
högr
e in
sulin
konc
entr
atio
n nä
r det
är m
öjlig
t.