Department of Adult Health Nursing, Faculty of Nursing, Kyoritsu Women's University.
Department of Biological Science and Nursing, School of Medicine, Yokohama City University.
Yakugaku Zasshi. 2023;143(10):865-870. doi: 10.1248/yakushi.23-00058.
Insulin therapy is one of the central treatments for diabetes mellitus. Insulin-derived localized amyloidosis (IDLA) is a known skin-related complication of insulin injection. This is one of the causes of poor glycemic control in diabetic patients on insulin therapy. The aim of this study was to review and update the findings on the extent and mechanism of reduced insulin absorption in IDLA. A literature search was conducted on decreased insulin absorption and its mechanisms, and nine references were selected, with seven of these on decreased insulin absorption and four on mechanisms. Insulin absorption at IDLA sites was reported to be 27-94% lower compared with normal sites. In addition, a comparison between nonpalpable and palpable IDLA sites revealed a significant decrease in insulin absorption at the palpable IDLA site. The mechanism of insulin malabsorption was found to be a reduction in insulin absorption at the palpable IDLA sites. Four mechanisms of decreased insulin absorption were identified: decreased subcutaneous blood flow, adsorption of administered insulin onto insulin amyloid fibers, impaired diffusion of insulin subcutaneously, and physical factors such as shaking of the insulin preparation. These mechanisms should be investigated in vivo in the future.
胰岛素治疗是糖尿病的核心治疗方法之一。胰岛素源性局部淀粉样变（IDLA）是胰岛素注射已知的皮肤相关并发症。这是接受胰岛素治疗的糖尿病患者血糖控制不佳的原因之一。本研究旨在回顾和更新 IDLA 中胰岛素吸收减少的程度和机制的研究结果。对胰岛素吸收减少及其机制进行了文献检索，共选取了 9 篇参考文献，其中 7 篇涉及胰岛素吸收减少，4 篇涉及机制。与正常部位相比，IDLA 部位的胰岛素吸收降低了 27-94%。此外，非可触及和可触及 IDLA 部位之间的比较显示，可触及 IDLA 部位的胰岛素吸收明显下降。胰岛素吸收不良的机制被认为是可触及 IDLA 部位的胰岛素吸收减少。确定了四种减少胰岛素吸收的机制：皮下血流减少、给予的胰岛素吸附到胰岛素淀粉样纤维上、胰岛素在皮下扩散受损以及摇晃胰岛素制剂等物理因素。这些机制将来应在体内进行研究。
