Lipohypertrophy - Injections And Lumpy Skin
Tweet Lipohypertrophy can be unpleasant for you from an aesthetic perspective and it can also affect the rate at which insulin is absorbed so can also lead to erratic blood glucose results. What is lipohypertrophy? Lipohypertrophy is when fatty lumps appear on the surface of the skin and is a fairly common side effect of insulin injections. This will usually occur if multiple injections are administered to roughly the same part of the skin over a period of time. When the skin becomes lumpy, it may mean that if insulin is injected into the lumpy area, it won’t be absorbed consistently, which can mean the insulin takes longer to be absorbed, leading to higher than normal blood glucose levels, or can get absorbed too quickly, leading to hypoglycemia. Symptoms of lipohypertrophy The signs of lipohypertrophy (lumpy skin) are a raised area of the skin where you tend to inject. The raised area may cover quite a wide area, say over an inch in diameter. The skin will usually feel firmer than the skin elsewhere on your body. Occasionally you may hit a vein when you inject which will result in some bleeding, leaving a raised area and a bruise over the next day or so. This in itself is not lipohypertrophy though. Diagnosing lipohypertrophy You may be able to recognise when you have lumpy skin but if you’re not sure, your health team can help to diagnose whether lipohypertrophy has formed and can help to advise you to help your skin recover and prevent it reoccurring. Treating lipohypertrophy Treatment for lipohypertrophy will usually involve making sure you don’t inject the affected area of skin until it has fully healed. The Plymouth Diabetes Service recommends avoiding into the affected area for at least 2 to 3 months. Preventing lipohypertrophy Lipohypertrophy is caused by Continue reading >>
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Painful Fat Necrosis Resulting From Insulin Injections
Go to: The case is a 34-year-old woman with long-standing type 1 diabetes mellitus with existing follow-up in the outpatient clinic at the Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, UHCW. She had maintained good glycaemic control and glycaemic stability with basal bolus regimen for many years. She had not developed any diabetes-related complications and had no other co-morbidities. Six months ago, she presented to A&E with sudden-onset, well-localised and severe pain in the right iliac fossa, just lateral to the para-umbilical area. Her biochemistry was normal. Ultrasound scan, however, revealed a right-sided ovarian cyst, which was thought to have caused pain to her. She was discharged from A&E with simple analgesia. On subsequent gynaecological follow-up 4 weeks later, her pain remained severe and examination revealed an exquisitely tender subcutaneous nodule at the same location measuring 2 cm in diameter. Magnetic resonance imaging (MRI) scan at the time revealed a 1 cm mass in the subcutaneous adipose tissue, which co-localised to her pain. The mass demonstrated a central fat signal surrounded by a peripheral ring: observations consistent with fat necrosis. There were other smaller subcutaneous nodules also observed in the left para-umbilical area. Subsequent surgical resection of the main area of fat necrosis was performed. The patient made an excellent recovery and her pain resolved post-operatively. Histology confirmed the presence of fat necrosis. Fat necrosis is a rare complication of s.c. insulin injection. This case illustrates the importance of considering this diagnosis in patients who inject insulin and develop localised injection-site pain. Fat necrosis is a rare complication of insulin injections that can manifest wi Continue reading >>
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Ask Joslin: Lumps Near Injection Sites
I have weird lumps near my injection sites. What are they? The condition is called lipohypertrophy, which is an abnormal accumulation of fat beneath the skin. It literally means enlargement (hypertrophy) of fat cells (lipo). Lipohypertrophy is most common in people who receive frequent, multiple daily injections of insulin or use an insulin pump. The hard bumps, usually found at injection sites, are an accumulation of fat and may also contain some scar tissue. Lipohypertrophy occurs when a patient uses the same injection site too often. Insulin acts on fat cells and encourages fat accumulation. However, there may be other contributing factors as well. Lipohypertrophy is more common in people with type 1 diabetes than those with type 2, though researchers are still unsure exactly why. A patients unique skin sensitivity may also play a role. Unfortunately, individuals may seek out these lipohypertrophic sites for injections since they tend to be less painful than at other sites. Not only does this make the lumps bigger, it can interfere with insulin therapy. The absorption of insulin can be erratic from these sites. Often, insulin absorption is delayed, leading to initial high blood sugars but later unexpected hypoglycemia. Lipohypertrophy itself is not life threatening, but it can make diabetes disease management more difficult. The best way to avoid abnormal tissue accumulation is to rotate your injection sites and use as much of the skin surface as you can, over the course of weeks or a month. It is also important to rotate insulin pump infusion sites as much as possible. That can be a challenge, but since infusion sets are in place for up to three days at a time, PWD on pump therapy are much more likely to develop lipohypertrophy. If you are using your abdomen to inj Continue reading >>
Lipohypertrophy
Lipohypertrophy[1] is a medical term that refers to a lump under the skin caused by accumulation of extra fat at the site of many subcutaneous injections of insulin. It may be unsightly, mildly painful, and may change the timing or completeness of insulin action. It is a common, minor, chronic complication of diabetes mellitus. Typical injection site hypertrophy is several inches or cm across, smoothly rounded, and somewhat firmer than ordinary subcutaneous fat. There may be some scar tissue as well, but the major component is adipose tissue, as insulin exerts a hypertrophic effect on adipose cells. To avoid lipohypertrophy, persons with diabetes mellitus who inject insulin daily for an extended period of time are advised to rotate their injections among several areas (usually upper, outer arms, outer thighs, abdomen below and around the umbilicus, and the upper parts of the buttocks). Rotation charts are often provided as part of diabetes education to help prevent lipohypertrophy. Lipohypertrophy usually will gradually disappear over months if injections in the area are avoided. It is a common misconception that the lump is largely scar tissue, as injection site hypertrophy is much rarer and milder with injections of other hormones and medications which lack the specific ability of insulin to stimulate adipose hypertrophy. In a sense, the "opposite" of injection site lipohypertrophy is injection site lipoatrophy, in which the subcutaneous fat around an injected area "melts away" over a few weeks or months, leaving unsightly, well-demarcated depressions in the skin. The mechanism of this local lipoatrophy is not understood and may involve autoimmunity or local inflammation. See also[edit] Involutional lipoatrophy List of cutaneous conditions [edit] Continue reading >>
How To Improve The Insulin Injection Experience
If you have type 1 diabetes, or if you have type 2 and have recently begun injecting insulin, you may have a bit of trouble getting used to the process of preparing and administering your own insulin shots. Andrea Penney, RN, CDE, of the Joslin Diabetes Center, says that injection technique is important to master not only for accurate dosing, but for comfort, too. "With proper practice and good technique, you can avoid pain during an injection," she states. Penney sat down with us recently to answer some common questions about insulin injection. If after reading and practicing insulin injections you still find you’re having trouble, Penney suggests seeing a Certified Diabetes Educator for more assistance. Q: How do I decide where to inject? A: People often select injection sites based on many factors: accessibility, presence of fatty tissue, and rate of insulin absorption (which will be discussed shortly). As a result, popular sites for injection include the stomach, outer thigh, the back of the arm (between the shoulder and the elbow), or the upper outside "wallet" area of the buttock (but not into the lower buttock area). Q: Once I decide on a location for an injection, how do I pick the right "spot"? A: Here are some easy guidelines: -Stomach If you’re going to inject into the stomach, stay at least two inches away from the bellybutton and/or any scars you may already have when using the abdomen for injections. -Thigh For an injection in your thigh, inject at least four inches or about one hand’s width above the knee and at least four inches down from the top of the leg. Do not inject insulin into your inner thigh because of the large number of blood vessels and nerves in this area. - Arm The area between the shoulder and elbow on the outside of the arm is usua Continue reading >>
Lumps And Bumps From Insulin Therapy
What are these lumps and bumps at my injection sites? Lumps and bumps from insulin are called lipohypertrophy. This is a medical word for a lump under the skin from an accumulation of fat at the site of many insulin injections. Scar tissue may also develop at the sites. Why does this happen? This happens due to the action of insulin on the fat cells. Insulin can actually cause fat cells to increase in size. It is generally seen when one uses the same area for insulin injection or infusion. It happens most often in areas that are easiest to inject insulin or place infusion sets-on both sides of the belly button and on the sides of the thighs. What happens when you have this? You may notice a thickening of this skin and areas of lumps and bumps. This was more evident with the older preparations of insulin where the skin changes were more evident. The changes may be very subtle with the newer insulin analogs so it is important to actually feel the areas that you use to inject or infuse insulin. You want to firmly stroke the areas in a sweeping motion to feel for any lumps. Does it affect your glucose control? Infusing insulin into areas of lipohypertrophy can affect your glucose control. Insulin is not always well-absorbed in these areas. You may find that your glucose control is not what you expect it to be. The more damaged the area is the more likely it is that glucose control will be affected. Sometimes the areas of lipohypertrophy have damaged nerve endings and you don’t feel your infusion set going it at all. This is clearly a sign of a damaged area. How is it prevented? Rotate your infusion sites! It is important to use different sites to prevent lipohypertrophy. You might want to use a calendar or body map to be sure that you are rotating you sites frequently. Av Continue reading >>
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 (LH)? 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 Continue reading >>
What Skin Problems Occur At Insulin Injection Sites?
Two main skin problems can occur at insulin injection sites: lipoatrophy and hypertrophy. With lipoatrophy, fatty tissue under the skin disappears, causing dents in the skin at the injection site. Hypertrophy is the overgrowth of cells, usually fat cells, that makes the skin look lumpy. It can look similar to scar tissue. By rotating the injection site, you can avoid some of these problems. There is also the possibility that some of the problems are caused by the type of insulin you are using. Lipoatrophy is probably caused by an immune reaction, although its exact cause is not known. Your body is responding to insulin as an injected “foreign” substance. This problem is not common with human insulin. Make sure you are using highly purified insulin, preferably human. Hypertrophy is not an immune reaction, so you don’t have to change your insulin if you are having this problem. But you do need to change injection sites to avoid this. When the same sites are used over and over again, fat deposits can accumulate in the area. This is also called lipohypertrophy. You may be reluctant to change because injections seem less painful in these areas. This can be true because the hypertrophy can numb the area. On the other hand, injections can sometimes be more painful in these areas. The abnormal cell growth can limit the absorption of your insulin. Do not inject into the lumps. Insulin action can be restricted by not being able to move through the tissue. Inject away from the lumps and remember to rotate the sites. Ask a member of your health care team to check your injection sites periodically. Continue Learning about Insulin Videos Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. Continue reading >>
Insulin Tumors
Swimsuit season lasts for at least five months in the South. The good news is that we live close to the beach, but the bad news is that after 25 years of living with diabetes (and three Caesareans), my body is starting to read like a map of my medical journey. Diabetes used to be an invisible illness. For years, no one knew that there was anything different about me unless I revealed it. I could sneak off to the bathroom and give myself a shot without anyone knowing. I could wipe the small dot of blood onto a tissue and return to the room, and my skin was unmarked and free from scars. I eventually gained enough confidence to come out of the diabetes closet and stop trying to hide my disease from the world. My journey toward acceptance began when I became a mother and discovered a surprising physical strength. This body that had been a source of shame, fear, and sadness transformed itself into something beautiful in pregnancy and motherhood. I am now the mother of three boys who shop with me every spring when it’s time for a new swimsuit. In years past, their small bodies crowded around me in the narrow, brightly lit dressing room, smiling and telling me I looked pretty in every single suit. They always made me feel beautiful even when my reflection didn’t live up to the expectations in my head. This year was different. “What are those bumps on your stomach?” Miles asked as I fastened the bikini top around my bra. My heart sank. I looked down at the two small lumps on either side of my belly button where I like to do my shots. “They’re from Mommy’s shots,” I said. “Ouch,” Miles said, and then, distracted, “Can we go look at the toys now?” I nodded, left the rest of the suits on their hangers, and ushered the boys out of the dressing room. I was no Continue reading >>
“help! There’s A Lump Where I Inject Insulin”
It might be a sign of lipohypertrophy, a condition that affects insulin absorption. Integrated Diabetes Services (IDS) provides detailed advice and coaching on diabetes management from certified diabetes educators and dieticians. Insulin Nation hosts a regular Q&A column from IDS that answers questions submitted from the Type 1 diabetes community. Q – Every time I think I know what I’m talking about when it comes to diabetes, I come across a new thing to worry about. I saw something about lipohypertrophy. What is it and should I worry about it? A – Lipohypertrophy is when fatty lumps appear on the surface, or just under the surface, of the skin. This is a fairly common side effect from insulin injections or insulin pump sites. It is more likely to occur if injections are administered to roughly the same part of the skin over a period of time, or if the same patch of body real estate is used for pump infusion sets over and over again. When the skin becomes lumpy, the insulin injected or pumped into this area won’t be absorbed as consistently as it once was, which can mean it will take longer to be absorbed or it will be inadequately absorbed. This can lead to higher than usual blood glucose levels. The signs of lipohypertrophy are a raised area of the skin at the injection or infusion site. The raised area may cover a wide area – up to an inch in diameter. The skin affected will feel more firm than the skin elsewhere on your body. The best treatment for lipohypertrophy is to avoid injecting or applying infusion sets in the affected area of skin until it has fully healed. Prevention is easier than dealing with lipohypertrophy after the fact. Make sure you pick a different area of skin for each injection and rotate your injection and infusion sites. Ideally, you Continue reading >>
Am I Injecting Insulin Properly?
Is it possible to get hard lumps under the skin when injecting insulin? I have experienced this problem while injecting more than one type of insulin, and I know the lumps are not from using the same injection site over and over again because I always rotate injection sites. But I also noticed when I took my postprandial blood glucose reading that I was up higher than normal. I'm curious as to whether the insulin is getting distributed correctly. Continue reading >>
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Swelling At Injection Sites
I been getting a pinkish swelling where I inject. Never used to get it but have the last couple of months. Bothers me, hurts and itches and lasts for several days. It's about 2-3 inches in diameter. It's been while using different insulin vials so it's not bad insulin. I just started injecting on my legs at nite and they do the same. The insulin is not cold when injected and I do it slowly. I hafta use 42 units at a time so I do 1/2 in one spot then move it over and do the rest. I showed my PA - she didn't seem to think it was a problem. All I can think of is that it's cuz I'm injecting more units. Same insulin altho before I did inject quicker and pinch the skin? Maybe I'll try that tonite. I'm starting to look like I've been playing with a swarm of bees! Moderator T2 insulin resistant Using Basal/Bolus Therapy I use large amounts of insulin. I have to use the 31 guage, 5/16" needles. I sometimes have to take a full minute to inject one shot. There is a theory with regard to insulin injection that insulin absorbtion is impared should too much insulin be injected into one site . . . . . were I to inject 42 units I would split it into four sites, not two . . . . . . more specifics on this can be obtained in Dr. Richard Bernstein's book(s) where he recommends the largest single site be topped out at no more than 7 units per injection..... Diagnosed type two at about age 40, now in my early sixties . . . . Using Metformin and three types of Insulin . . . . last a1c was 5.4 - September of 2009 Nan-OH - My needles are 8mm- 31 gauge. I'll try going slower. Steve K- guess I missed that in Bernstein's book! I'll give it a try going with 4 injections. I kinda thought that as it number went up the swelling showed up more. I know he said that the resistance is higher the more ins Continue reading >>
Inject Insulin? Those Old Lumps & Bumps Explained
Calling All Diabetics: Anyone have stubborn, pesky lumps at old injection sites they can’t get rid of? Lumps that may reduce in size but still remain despite years of avoiding the injection site area(s)? I have three particularly stubborn lumps that I’ve had for over ten years. These lumps (fancy term: lipohypertrophy) are located on my left upper arm, right quadrant of my abdomen, and a small lump on a cheek ('nuf said). Disclaimer: I was diagnosed with Type 1 Diabetes in 1989 and injected “Regular” and “Lente” insulin at least twice daily for many, many years. While I am on an insulin pump, I tend to avoid the abdomen area for sites because of this reason. Diabetics who’ve been around for a while like me have likely dealt with this issue at one point or another. Lumps at various injection sites was a major problem with the older so called “impure” insulins, and while the problem improved quite a bit with the advent of “better” insulins over the years, it is not out of the question that such lumps may form, especially at sites the diabetic tends to “favor” or use most frequently. Nowadays, a subtler manifestation lipohypertrophy is common. Instead of the stubborn lumps I’m dealing with, diabetics now tend to see a thickening of the skin around the area as opposed to the stubborn formation of lumps. While the lumps may not occur, there is often a very real change in the absorption rate of insulin at these sites, and that can have a very real impact on overall glucose control. That said, it’s something none of my endocrinologists or N.P.'s or diabetologists ever thought to comment on or even notice until I brought it up. This doesn’t mean it’s not important, just that docs may not always be on the alert as much as they should be. Why Bad Continue reading >>
Nodules Of Fibrocollagenous Scar Tissue Induced By Subcutaneous Insulin Injections: A Cause Of Poor Diabetic Control
Insulin injections can cause a variety of subcutaneous changes, particularly if patients do not rotate sites. This includes lipohypertrophy, lipoatrophy,1,2 and rarely infections. The extensive use of human insulin has reduced the prevalence of lipoatrophy but lipohypertrophy remains a significant clinical problem occurring in 27–48% of patients.1–3 Lipohypertrophy can lead to erratic insulin absorption4 and is unsightly. There are few reports of injection site problems in the recent literature. We report a case of a previously undescribed phenomenon of bilateral large hard subcutaneous nodules at abdominal wall injection sites. Examination of 73 further patients with type 1 diabetes revealed lipohypertrophy in many cases, two of whom had also developed hard subcutaneous nodules. CASE REPORT A 46 year old man with type 1 diabetes of 24 years’ duration presented with an abscess on his scalp. There had been a weight loss of 11 kg and worsening diabetic control (glycated haemoglobin (HbA1c) increased from 10.6% to 16.5%) despite increased insulin dose over the past 12 months. He had a history of microalbuminuria, peripheral neuropathy, background retinopathy, cerebrovascular disease, and hypertension and was taking Human Mixtard 30 insulin 26 units twice daily. For years he had given all his insulin injections into the abdominal wall. He had bilateral 8 × 8 cm areas of typical lipohypertrophy (see fig 1) which both contained “woody hard” smooth 4 cm diameter nodules that felt like golf balls. He said he always injected insulin into these nodules. Biopsies of the core portion of one of the lesions revealed dense hypocellular and hypovascular collagen with bland looking fibroblasts and foci of necrosis. The appearance was that of collagenous scar tissue. There was Continue reading >>
Injection Sites - Lumps?
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community I've been told not to use my arms for my injections because they aren't big enough so to use my stomach and legs which I always have..but for the past 8 months or so every time I inject without a doubt I get huge painful lumps in both my legs and my stomach, I inject 5 times a day but I feel I'm running out of options as to where to do it as it's just too painful, the hospital at my last appointment gave me smaller needles and said they should help but if anything it's even worse..anyone else have this problem and recommend anything to stop the lumps? I used BD micro fine ultra needles and have had no problems with them I used to be on the 5mm ones of those but now they have given me these and there's still now change Do you get lumps from both your insulins? Are they fatty lumps or kind of temporary lumps under the skin immediately after you do your injection? Yes both insulins I use cause my lumps, they are like hard white lumps, that's sore to touch and last a few days after..and sometimes they don't show for a few hours after taking my insulin, I used to be on the BD needles but when they put me on the smaller they changed me to these I use BD needles too... find they're the best. I hope these lumps ease up for you. I have the fatty lumps which I avoid when injecting... also doing 5 injections per day on average. @jordanneshort sounds worrying hope you find a solution soon. For the record I use the same BD microfine 4mm needles.. not many probs at all tho I have only once had a lump on injecting. I had a burning sensation too when I administered my background insulin of 12 units.. I guess I caught a vein.. the lump was sore and lasted about 24 hrs Continue reading >>
