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Injection Site Complications Lipodystrophy/Lipohypertrophy One complication specific to patients using injection therapies is damage to the adipose tissue.
Rarely, overuse of injection sites can lead to the breakdown of fat tissues, referred to as lipodirstrophy. This can be both cosmetically distressing for patients but also destroys the fat layers that are needed for effective medication absorption. It often feels spongy and soft before actual depressions are visible. But more common is lipoatrophy or -hypertrophy. This is a hardening and thickening of the fat layer. It often leads to rubbery or even pebbly-like areas in the fat layer. Again this causes a marked slowing in the absorption of medications which can lead to dangerous dosage increases, hyper- and hypoglycemia as well as cosmetic concerns for patients.
Signs of Diabetes Distress
I often tell my patients, diabetes does not kill people, not managing diabetes does. Diabetes distress is the term for the behavioral health decompensation that leads to unmanaged diabetes. As clinicians we need to discuss struggles and mental status with our patients at every encounter. Formal anxiety, stress and depression screening tools should be used regularly for all patients and caregivers of people with diabetes. The signs of diabetes distress are very much like the cycle of grieving one should experience when diagnosed and living with chronic diseases. However, when those symptoms begin to inhibit one’s experience of life, one’s ability to perform tasks of daily living, or health and safety, urgent and even intensive behavioral health intervention is needed.
Signs of Diabetes Distress include: -Denial patients who do not take medication, decline to start medication, eat, exercise, or drive without consideration for impacts on blood sugars. -Avoidance Patients who don’t check blood sugars, who don’t get labs done or routinely cancel or reschedule appointments.
-Depression
-Patience
who express hopelessness in their ability to make
positive movement toward goals, or who view their
diabetes management as a punishment/or pointless
struggle
-Anxiety
-Patients
who express fears for long term health impacts of
clinically acceptable elevations or drops in blood
sugar, patients who struggle with needle or
pharmiaophobia
-Anger
-Patients
who are frustrated, often with clinicians or
institutions surrounding their diabetes management.
They may express feelings of persecution or
stigmatization.
-Disordered
Eating
-Patients
who eat without regard to blood sugar impact, or
hyper control eating to excessive degrees to avoid
impacts on blood sugars. Particularly those who do
not eat in a way that meets their daily nutritional
requirements or patients who avoid changes in
routine or become compulsive about food preparation
to the point of isolation or upset.
-Lack
of Self Care
-Patients
who do not perform tasks of daily living, get
medications refilled, see needed doctors, take
educational / social opportunities etc.
-No
one living with diabetes distress can possibly hope
to manage their disease well enough to prevent all
the other complications we have learned about today.
So Behavioral health interventions really are the
keystone to good diabetes management.
Summary The key points to stress from this program are: Now that we know the common diabetes-related complications which are often seen, we now know how to help our patients reduce their risks of complications.We have seen that complications are widespread and significant--and that while glucose dysregulation is a central causal factor; early screening and aggressive treatment makes an enormous difference.
And that b y understanding the physiology of the various complications, interventions and screenings available, we can help our patients living with diabetes to thrive with less fear of complications.
That concludes this program. To receive CE credit for participating, please click the link below:
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