Lipohypertrophy

Dr.Mitalee Barman
Diabetologist , MVH

Lipohypertrophy is a fatty tumour- like growth at or around the injection site. These spongy growths result when insulin has been injected over and over again into a single area. Over time, the skin around the hypertrophied area becomes numb. People with diabetes, who continuously use a single area for injecting insulin, develop lipohypertrophy over a period of time. They then add to the problem by continuing to inject into this area because they do not feel any pain while injecting. However, it is not the same in all cases as some people feel pain at the site.

Treatment:

The treatment consists of systematically rotating injection sites.

It is your choice where you want to inject. You will get the best results if you are consistent because insulin is absorbed at different rates in different body areas and inconsistency could cause your body to respond differently to each injection.
Insulin is absorbed most swiftly when injected into the abdomen, more slowly in the arms, and even slower in the thighs and buttocks.
Other factors that affect insulin absorption are temperature and exercise. The greater the temperature is, the greater the rate of absorption. Exercise or massage may increase absorption leading to large fluctuations in blood glucose levels.
 

Prevention:

Rotation of sites is important to prevent lipohypertrophy.

Instead of randomly using different areas for each injection, some doctors recommend that individuals with IDDM inject in a given area before moving to another. For example, using areas in the abdomen systematically before moving to the deltoid becausean injection in the abdominal area and an injection in the hip have different rates of absorption and it may be difficult to interpret the body’s response to dosage.

Another approach is that if you eat a big breakfast and need a faster response from insulin,
but a slower one from night insulin because you like to go to bed early and want night insulin to last all night, in the morning you can use the abdomen and at night the thighs.

Based on your needs, your diabetologist will be able to suggest a rotation plan, which you must follow.

Typical injection sites
 

The best site is a layer of fat above a muscle tissue. Don’t inject into muscle tissue anywhere in the body.Several areas of the body have enough fat tissue under the skin for insulin injection.
Insulin is absorbed most quickly and at the most consistent speed from one injection to another in the area of the abdomen, except for a 2 inch circle around the navel. The tough tissue around the navel causes inconsistent absorption.
Another suitable area is the top of the outer thighs which is best used in a sitting position. The backs of the upper arm, hips and buttocks also work well.
Keeping these points in mind, divide the body area into injection sites about the size of a coin and try to keep each new injection at that distance from your last shot.

At MVH, we teach our patients to inject on the abdomen and thighs.

Precautions

Avoid the deltoid muscle - the large triangular muscle that covers the shoulder joint.
Avoid injecting too close to moles, scars.
When injecting in the thighs, avoid the inner thighs Use  the top and outward areas. Friction between the legs when moving about may make the inner thigh sore.
Persons who exercise should avoid injecting into subcutaneous tissue adjacent to the muscle to be used as rapid absorption can lead to hypoglycemia.