The site of insulin storage inside domestic refrigerators is associated with ketoacidosis and hypoglycemic episodes among patient with diabetes mellitus

Hyder Osman Mirghani, Eid Farij Alatawi, Nawaf Moqbel Albelwi, Mofareh Jubran Alrasasimah, Turki Hamdan Albalawi, Hussam Abdullah Albalawi


Insulin storage is vital for use in type 1 diabetes and most patients with type 2 diabetes mellitus. No researchers have investigated the site of insulin storage inside the fridge, the proper rotation of insulin injection sites, and the worsening glucose profile in Tabuk, Saudi Arabia.

The study aimed to assess the association between storing insulin in different sites of the fridge, rotating insulin injection sites, hypoglycemia, and ketoacidosis.

This is a cross-sectional study conducted in King Fahd Specialist Hospital, Tabuk, Saudi Arabia during the period from May 2019 to November 2019, 394 participants were approached to collect demographic data, site of insulin storage in domestic refrigerators, number of ketoacidosis and hypoglycaemic attack during the last year, number of insulin injection sites and rotation of injections, and if the patients were regularly checking their glycated haemoglobin.

Of the 349 patients (98 per cent had type 2 diabetes), 98.3 per cent had a hypoglycaemic episode during the last year, and 11.2 per cent were admitted for ketoacidosis, this is mirrored by not properly storing insulin inside the fridge (39.2 per cent), and inappropriately rotating insulin injection sites (87.4 per cent). Patients who were storing their insulin inappropriately had higher rates of both ketoacidosis and hypoglycaemia than their comparators (0.26±0.65 vs. 0.11±0.39, and 19.51±19.46 vs. 7.07±9.54 respectively, P < 0.05.

Hypoglycaemia and ketoacidosis were common among patients who inappropriately store insulin inside the fridge and wrongly rotate insulin injection sites. Further larger multi-center studies investigating the patient's behaviour to high and low blood sugar and the rates of lipohypertrophy are recommended.
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