TÉCNICAS DE APLICAÇÃO DE INSULINA E SUA RELAÇÃO COM A EFICÁCIA DO TRATAMENTO: REVISÃO DE EVIDÊNCIAS NO DIABETES TIPO 1.

Resumo

INSULIN ADMINISTRATION TECHNIQUES AND THEIR RELATIONSH IP WITH TREATMENT EFFICACY: A REVIEW OF EVIDENCE IN TYPE 1 DIABETES Rafaela Dedemo Mesquita Lima ¹; Ana Carolina Alvares Dalto Ribas²; Iasmin Teruel Maia¹; Victor Eugênio Bezerra¹; Roger Marcelo Mesquita da Silva³; Marcia Rocha Gabaldi 4 . ¹ Pharmacy student, Pharmacy undergraduate program, University of Marilia (UNIMAR), Marilia, São Paulo, Brazil ² Biomedicine student, Pharmacy undergraduate program, University of Marilia (UNIMAR), Marilia, São Paulo, Brazil ³ Postgraduate student in the Structural and Fu nctional Interactions in Rehabilitation program, University of Marilia (UNIMAR), Marilia, São Paulo, Brazil ⁴ Professor in the Department of Biochemistry, Pharmacy and Biomedicine courses, University of Marilia (Unimar), Marilia, São Paulo, Brazil ABSTRACT Introduction: Type 1 Diabetes Mellitus (T1DM) is an autoimmune disease characterized by the destruction of pancreatic beta cells, resulting in absolute insulin deficiency and the need for exogenous replacement through subcutaneous injections throughout th e day. Inadequate insulin administration techniques may compromise therapeutic efficacy, including practices such as needle reuse and lack of rotation of injection sites, factors that interfere with subcutaneous insulin absorption and contribute to glycemic variability and metabolic imbalance. Due to the chronic nature of the disease, treatment requires patients to develop precise technical skills to ensure that insulin reaches the subcutaneous tissue in an appropriate and predictable manner. Objectives: To analyze the main errors related to insulin administration techniques and their influence on therapeutic efficacy and glycemic control in patients with T1DM, highlighting the pathophysiological consequences of improper administration. Methods: This is a na rrative literature review conducted using the PubMed and SciELO databases, through the use of descriptors related to insulin, subcutaneous injections, lipohypertrophy, administration techniques, and health education. Studies published in the last five years, in English, were included. Results: Evidence shows that proper rotation of injection sites is essential for maintaining predictable insulin absorption and should be performed in recommended regions such as the abdomen, thigh, buttocks, and arm, not only across different anatomical areas but also within the same region, by dividing it into quadrants or equivalent areas, respecting a minimum interval of 1 cm between injections. The insertion angle should be 90°, with the use of 4 mm or 5 mm needles recomme nded without the need for a skinfold, and 6 mm needles with a skinfold, ensuring proper deposition in the subcutaneous tissue. Non -adherence to these practices is associated with the development of lipohypertrophy, characterized by structural changes in adipose tissue, including adipocyte hypertrophy, formation of nodules, and possible local inflammatory processes, which may impair insulin diffusion and pharmacokinetics, resulting in erratic absorption and increased glycemic variability. These nodules alter insulin pharmacokinetics, leading to unpredictable absorption that may result in both unexplained hyperglycemia and severe, unexpected hypoglycemia. In addition, needle reuse increases tissue trauma and the risk of local infections, further compromising t he integrity of injection sites. Conclusion: Proper insulin administration technique plays a determining role in therapeutic efficacy and glycemic control in patients with Type 1 Diabetes Mellitus. Continuous training and periodic review of injection techn ique should be integrated into the routine care of the entire interdisciplinary team. In this context, Pharmaceutical Care associated with Health Education in the outpatient setting is an essential strategy to optimize insulin use, reduce glycemic variabil ity, and improve clinical outcomes.