Lipohypertrophy

Lipohypertrophy is a lump that forms under the skin. It is an accumulation of fat that forms in sites where there are repeated subcutaneous injections of insulin. The buildup of fat can be unsightly and mildly painful. It is typically smoothly rounded, somewhat firm, and can range from centimeters to inches across. The size will typically depend on how closely the injections are placed together as well as how often insulin is injected in that particular area. Lipohypertrophy can also affect the absorption rate of insulin which can lead to blood glucose levels that are either too high or too low.

If you suspect you are developing lipohypertrophy, talk to your doctor and stop injections at that particular site immediately. Lipohypertrophy will generally disappear after injections are stopped in the affected area over a period of months. In severe cases, liposuction may be needed to remove the fatty buildup. Your doctor may also want to change the type of insulin or needles that you are using to avoid the problem in the future.  

To avoid lipohypertrophy, you need to rotate injection sites. As a part of diabetes education, you should be given a rotation chart. If you do not have a rotation chart your health care team should be able to provide you with one. This will help you to remember where you have been injecting insulin, and where you should be in the future.

There are four areas that are recommended as injection sites including the abdomen, thigh, arm, and buttocks. Keep in mind that insulin absorption rates may vary from site to site, which could affect blood glucose levels. When choosing an injection site, make sure the area is free of moles, scars, skin blemishes, varicose veins, and cuts. The abdomen is the preferred injection site for many people as insulin is absorbed more quickly and predictably there. Choose an area between the bottom of the ribs and the pubic area and avoid injecting within two inches of the belly button.When picking an injection site on the thigh, look for a spot at least four inches below the top of the leg and four inches above the knee. The fatty area on the back of the arm between the shoulder and elbow is also a good injection site. When injecting in the buttocks try to not inject the area you sit on, instead opt for the area your pockets would normally rest.

Your diabetes management team should be able to answer any questions you may have about treating and avoiding lipohypertrophy. As with many complications of diabetes, education and prevention are the most important steps you can take to avoid developing the complication in the first place.  

[hupso]