Discussing the local reaction of insulin, Banting, Campbell and Fletcher1 warn against the intramuscular injection, saying that this adds to the subsequent pain and tenderness and is sometimes followed by induration. Early stinging effects of the extract were ascribed to the salt content, and removal of the salt overcame that difficulty. They state that tenderness varies with different preparations of insulin, and that at its worst it is confined to slight induration involving the subcutaneous tissue, with reddening of the skin immediately surrounding the point of puncture. They find these effects not so great as those following the injection of pituitary extract, caffein, theophyllin, digitalin, strophanthin or camphor, and that they do not compare with, local effects from doses of vaccines. They note that there is no active pain, merely a tenderness to pressure. They suggest injection of areas not subjected to pressure.
Wilder, Boothby, Barborka, Kitchen and Adams
Sturtevant M. LOCAL ANAPHYLAXIS FOLLOWING INJECTION OF INSULIN. JAMA. 1924;82(12):964. doi:10.1001/jama.1924.26520380002012a
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