每日一题_2024.06.13

A 65-year-old man with type 2 diabetes was admitted to the hospital with hyperosmolar hyperglycemia state. Two weeks before admission, the patient’s insulin dose had been increased owing to inadequate glycemic control. The physical exam was notable for confusion and sarcopenia. There were also rubbery, subcutaneous masses on either side of the umbilicus where the patient had been repeatedly administering insulin injections. Which of the following should be done to prevent this finding?

一位65岁患有2型糖尿病的男性因高渗高血糖状态被送入医院。入院前两周，由于血糖控制不足，患者的胰岛素剂量有所增加。体检时发现患者有意识混乱和肌肉萎缩。在患者反复注射胰岛素的脐周两侧，也发现了一些橡胶样的皮下肿块。为了预防这种情况，应该采取以下哪种措施？

A. Cool site before injecting 注射前先冷却注射部位

B. Discontinue the use of irritating cleansing solutions at injection sites停止在注射部位使用刺激性清洁溶液

C. Massage the injection site after injecting注射后按摩注射部位

D. Rotating insulin injection sites轮换胰岛素注射部位

E. Use smaller needles使用更小的针头

答案解析：

皮肤发现与胰岛素引起的脂肪增生一致。胰岛素引起的脂肪增生是一种局部性脂肪营养不良，由在同一部位反复进行皮下注射引起。这可能导致对胰岛素治疗的反应降低，因此血糖水平波动。在肥胖患者中，脂肪增生可能难以检测，但腹部检查时通常可以触摸到肿块。使用皮下胰岛素的患者应在每次门诊时检查注射部位的并发症，并应接受有关轮换注射部位重要性的咨询，以使注射部位得以愈合。

正确答案：D