The Lumps and Bumps of Diabetes: Understanding Lipohypertrophy

Do you manage your diabetes with insulin? If you answered “yes,” then I strongly encourage you to read the following article. The focus of this article is lipohypertrophy; as this word is quite a mouthful to say, it is often shortened to LH.

So what exactly is lipohypertrophy in diabetes?

• Lipohypertrophy is the most common skin lesion (abnormal skin condition) that occurs with insulin injections. LH is an abnormal accumulation of fatty tissue under the skin at the site where insulin is injected. When touched, these areas feel hard and/or rubbery. On visual inspection LH may look like a lump or bump.

How common is lipohypertrophy?

• The reported prevalence of LH, in patients receiving insulin, varies widely. However, is it estimated that approximately 50 percent of those with diabetes (*using insulin) have some degree of LH.
• Health care providers should be inspecting injection sites at each appointment as part of the regular examination. However, as one study noted, according to patient reports, only about 30 percent of patients had their injection sites inspected at every appointment.
• Areas that develop lipohypertrophy often lose sensation over time; as a result, these areas become favored over other injection areas as there is less discomfort. This in turn may further worsen LH.

What causes lipohypertrophy?

• Lipohypertrophy results from repeatedly injecting insulin into the same site.

How does lipohypertrophy impact diabetes control?

• Reduced insulin absorption
  • Studies have reported that insulin being injected into areas with LH may block insulin absorption by as much as 34 percent.
  • Post meal blood glucose levels can range from 17 percent to 54 percent higher in those injecting insulin into areas with LH.
• Unexplained hypoglycemia
  • The occurrence of unexplained hypoglycemia may be as high as 39 percent (those with LH) in comparison to 6 percent (those without LH)
  • Unexplained hypoglycemia may in part be explained by improved insulin absorption if a different site without LH is used (but insulin dose is not lowered/adjusted).
• Greater glycemic variability (greater swings in blood glucose levels)

What can be done to prevent lipohypertrophy?

• Rotate injection sites or infusion sites (if you use an insulin pump)
  • Injection sites should be rotated within regions and between regions
    • Reminder: Insulin injection site regions: abdomen (2 inches away from navel), back of upper arm, outer thigh, and upper buttocks
  • Each injection should be at least 1 to 2 inches away from the last injection site.
• Always use a new insulin syringe or pen needle tip
• Avoid injecting insulin through clothing
• Avoid injecting cold insulin
• Give the area with LH a rest. It may take weeks to years to resolve.
• If your physician does not inspect your injection sites, request that he/she do so.
• Inspect injection sites on your own. Look for areas that appear raised or puffy. Feel for hard or rubbery, lumps or bumps under your skin. Make sure to report any findings to your physician.

Have you experienced lipohypertrophy? Please share you experience here with the type2diabete.com community.