Subcutaneous tissue thickness in children with type 1 diabetes

Abstract

This paper reports a study to measure the thickness of subcutaneous tissue at three major injection sites and to identify frequently used injection sites and injection methods. Glycaemic control is the key factor in the management of children with type 1 diabetes, and subcutaneous injection of insulin plays a major role in glycaemic control. However, only limited studies have examined the thickness of subcutaneous tissue at various injection sites. The subcutaneous thickness in a convenience sample of 65 children aged 8-16 years attending a diabetes camp in 2002 was measured once per child at the outer arm, anterior thigh, and abdomen by one investigator using a Lange caliper. Injection sites and the method of injection were observed daily for four days by a trained investigator using a checklist. Median values of subcutaneous thicknesses at the outer arm, anterior thigh, and anterior abdomen for girls were respectively 18.00, 18.00 and 19.75 mm, and for boys were 17.00, 12.50 and 17.00 mm. In 40% of participants, the thickness of the subcutaneous tissue of the abdomen was <12.5 mm. Boys over 14 years old had statistically significantly thinner subcutaneous tissue at all injection sites than that of age-matched girls. The anterior abdomen was the most common injection site in boys, and the anterior thigh in girls. Perpendicular injection without skin-folding was the most frequently used injection method. Body Mass Index was statistically significantly correlated with subcutaneous tissue thickness at all sites. A needle shorter than a 12.5-mm needle should be used, particularly for boys. Injection with skin-folding may decrease the possibility of intramuscular injection.