Le tissu sous-cutané et l'insuline : Une cohabitation délicate Revue de la littérature

Insulin, used for almost a century, is the treatment of millions of people worldwide, and the injection remains the only truly usable way to administer this vital therapeutic. Yet the injection gesture remains poorly known by particularly physicians and nurses, although more studied than we imagine. This article aims to give an update on the knowledge about anatomy of the subcutaneous tissue and the effects of insulin injection in this tissue. Reference is made to the concept of tissue thickness, injection depth, site (abdomen, limbs, others areas of injections), speed and duration of the gesture, and therefore of the material used. Especially today it is well established that -except for very rare exceptions- needle length should not exceed 4 mm whether the subject is an adult or a child, thin or fat. It is also dealt with lipodystrophy and their impact on the absorption of injected insulin, in general the effect of the injection technique on the pharmacokinetics, pharmacodynamics, variability and reproducibility, and consequently on glycemic control of patients using insulin. This article is a review of the international literature on the topic (Cochrane, PubMed, Medline).