Lipohypertrophy is an abnormal accumulation of fat underneath the surface of the skin. It’s most commonly seen in people who receive multiple daily injections, such as people with type 1 diabetes.
Loading the player...Insulin Injection and Lipohypertrophy Robert Roscoe, BSc. Pharm, ACRP, CDE, CPT, Pharmacist and Certified Diabetes Educator, talks about what lipohypertrophy is and how to avoid getting them when injecting insulin.
Lipohypertrophies, or lipos, are the development of scar tissue in the subcutaneous fat layer where you do your insulin injections. They feel like a thick, rubbery consistency underneath the skin. The issue with those is that sometimes you can feel them more than see them.
Injecting into a lipo changes how insulin is absorbed. So, when people inject into the lipos, they may find they’ll have bigger swings in their blood sugars or may actually have unexpected lows because of it.
The risk factors in developing a lipohypertrophy are usually two-fold. Number one, not rotating your injection sites well, and into the same site repeatedly. And secondly, re-using your needle tips is an additional factor as well.
The way you self-inspect for lipohypertrophies is basically you think about the areas where you do your injections. So, you can do this one of two ways. Number one, you can stand in front of a mirror, you can use a hand cream or hand lotion and start slightly to the side of where you normally do your injections, and use two fingers and slowly press and head to the area you usually do your injections.
By doing that, you may feel a difference in consistency from one area to the other. So, if it feels nice and soft in one area or a little bit thicker in the other, then you’ve identified having a lipohypertrophy. The second method, which is also commonly used, is when people are showering. They may not be able to see their lipohypertrophies, but with their hands being nice and soapy, they would follow the same procedure, by actually going from an area where they don’t do their injections to an area where they do, and they would try to feel if there’s any difference in consistencies in that method as well.
So if you find that you have a lipo the first thing to try to do is to find a healthier site. Sometimes you need to contact your healthcare team, because moving to a healthier site may change your insulin dose, so you may need some advice in that area.
The other thing you need to do is think about your rotation practice. Again, if you haven’t practiced good site rotation, this is kind of a reminder to look at soft spots when you’re doing your injection to make sure you find healthy tissue each time. If you find that you have a lipo, the first thing to do is avoid that area. Look for softer tissue to do your injection.
Also, notify your diabetes healthcare team, because they should help you in finding these lipos and then provide advice in terms of how to avoid them and what to do with your insulin dose. If you’re moving your dose to a softer area, it may be important to do a little bit more self-monitoring, just to see how the new site is working.
Once you find that you’ve have a lipo, the common question is how long will it take for it to go away? It really depends on how long it’s been there, and how often you’ve been injecting into that particular site. We are now having some evidence that in three to six months we actually can have a real large reduction in that site of 50 percent, or in some cases it can disappear altogether.
The important thing to remember is that once you’re avoiding that site of lipohypertrophy, insulin is going to work a little different. So, make sure you talk to your healthcare team about what insulin dosage you should be using, and to revisit proper rotation styles, to make sure you’re avoiding that site altogether. Injection sites should be checked by a healthcare professional or your endocrinologist as well as yourself on a regular basis. It’s important to remember that injecting into healthy tissue allows the insulin to absorb properly, and gives it the expected action of insulin that’s anticipated.
For more information, I would encourage you to contact your healthcare professional. This includes your endocrinologist, or your family doctor, as well as your healthcare team. This could include diabetes nurse educators, certified diabetes educators, pharmacists and dietitians for further information.
Presenter: Mr. Robert Roscoe, Pharmacist, Rothesay, NB