Diabetes Self-Management Blog

Good skin makes us attractive, maybe because it signifies health, and health is sexy. But diabetes can harm skin in several ways. What can we do to protect ourselves?

I hadn’t thought about much about skin care until a reader named Ron wrote,

I have developed injection site nodules. One is right under my belt line and has become painfully sensitive when touched. I’m a 20-year Type 2 diabetic and my primary care docs have never checked for this or warned me.

What do you think is going on with Ron, and is it important? I don’t know, but possibly he has developed “lipohypertrophy,” a skin problem only people with who inject insulin get. It’s caused because insulin makes fat cells grow.

In the Postgraduate Medical Journal, an examination of 73 people with Type 1 found that 44% had developed lipohypertrophy (which translates as “overgrown fat”). For most, it was just unsightly and annoying hard lumps under the abdomen. But for some it caused “marked deterioration of diabetes control.” That was because scar tissue had started growing inside the lumps, so the insulin wasn’t absorbed well.

The people who continued to inject into the hardened areas were going downhill fast. All the study participants improved when they changed injection sites and started rotating them.

According to Wikipedia, “Typical injection site hypertrophy is several inches across, smoothly rounded, and somewhat firmer than ordinary subcutaneous fat. There may be some scar tissue as well.”

We know that insulin promotes weight gain. I wonder if lipohypertrophy occurs throughout the body and might be part of the problem.

There are many other skin problems associated with diabetes. Most are not caused by injections. Dr. May Leveriza-Oh wrote a good piece on diabetes and your skin on our site in 2009. It’s worth reading if you have any skin issues.

Dr. Leveriza-Oh writes that diabetes constantly pushes us toward dehydration, as extra glucose takes water out of circulation. So dry skin is common, leading to

other skin problems such as itching (and often scratching), cracking, and peeling. Any small breaks in the skin leave it more exposed to injury and infection. It is therefore important to keep skin well moisturized.

One way to do that is to keep yourself hydrated by drinking fluids. Another is to oil or moisturize your skin regularly. My partner Aisha has been oiling her skin every day for 50 years or more, and she still looks great at 62.

But it’s more important than looks. Dryness and cracking makes skin more vulnerable to skin infections. Bacterial infections can include “folliculitis,” which is inflammation of hair follicles and is not too serious. Infections can range from there, to impetigo, all the way up to gangrene, a deep tissue infection that can lead to amputation or death.

Dr. Leveriza-Oh also warns of fungal infections like tinea and candida. Tinea infections come in different forms, like ringworm, athlete’s foot, or jock itch, and are usually characterized by itching and scaling. They can become super infected by bacteria, especially from scratching and skin cracking. So get them treated. Antifungal creams are widely available over the counter. Sometimes a healing skin lotion including aloe helps, and I’m sure there are other good products.

Dr. Leveriza-Oh also describes many less common skin conditions specific to diabetes. Among others, these include diabetic dermopathy, digital sclerosis, and scleredema audoltorum — thickening of skin on hands or neck. I encourage reading the whole article. Here’s the link again.

Skin care is important, but all of these problems are best prevented or treated by improving glucose control. From the reports I’ve seen, these conditions rarely affect people whose A1C is close to normal.

For people like Ron, whose skin problems are clearly related to injections, Amy Campbell has a lot of advice in this article.

The 10-second version is:

• You can use shorter needles to inject. A 4- to 6-millimeter needle works as well as the usual 8- or 12.7-mm versions.

• You don’t need to pinch up the skin to inject, unless you’re using an 8- or 12.7-millimeter needle.

• Rotate your sites — good injection sites are the back of the arms, the abdomen, the upper buttocks, and the upper, outer thighs. Using the same ones all the time sets up lipohypertrophy and other problems.

• Insulin injections shouldn’t hurt — if they do, check with your educator or doctor. Either you’re doing something wrong or they are.
Read all about it here.

These days, people are injecting medicines other than insulin. Byetta (generic name exenatide) sometimes causes swelling and itching at injection sites, although it usually goes away after a few days. The same is true of Symlin (pramlintide), according to information from the National Institutes of Health.

Glucose monitoring can also hurt skin, but usually only by toughening the fingertips and making them rough. See advice for painless glucose monitoring here.

I’m hoping all our readers can have healthy, sexy, attractive skin. It’s an indicator of general well-being; it’s important for health; and why not look good? If you have any advice to share or questions to ask, please comment.

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Comments
  1. The patient information guide packaged with BYETTA clearly
    illustrated PINCHED UP SKIN.

    I had this problem….until a human said “don’t do that.”
    “But the instructions…..”

    My meds are shipped to my home. No human illustrates, leaving me dependent upon the instructions.

    I finally stopped Byetta when Medco could no longer get a refrigerated product to me……. under refrigeration.

    Point? The information provided by this website is very valuable.
    Thank you, David….
    from all of us for whom ‘5 minute’ appointments fail.

    Posted by CC Ballard |
  2. David - Great article on skin.

    Suggestions for Injection site, finger tips and wight gained using insulin.

    Rotation Site: The INSIDE of the upper thighs. It is a very tender spot and some people may not want to try. I did. After 56 years as a Type 1, there were not many body areas I have left not used! :0)) I am glad I found this one!

    Finger Tips! Every week I take an Emory board and “sand down” my finger tips. They are soft and smooth again. Sanding the tips down removes the built up thicker skin formed. I know this may sound rather foolish or useless thing to do but it does work! I do this every week and have no ugly marks on my finer tips and they are very soft.

    Wight gained from insulin. Naturally, if we eat too much and make poor choices of meal contents! Usually, the more we eat of what we should not the more insulin we need! Dah!

    Cheers!

    Posted by joan |
  3. Our editor Ingrid Strauch pointed out that I should explain what “site rotation” means. It could be misunderstood as “rotating the syringe around after puncturing the skin.” It doesn’t mean that. It just means changing injection sites often, probably with every injection is best.

    Posted by David Spero RN |
  4. Before I started using my insulin pump (1998), I had huge areas that were like sink holes. There was no fat under these areas, so I couldn’t inject there. After much discussion, my CDE, RN wrote to the company that made my insulin & their best guess was that I may have developed a very rare allergy to my insulin. It may have been to an additive in the insulin. Of course, I had been injecting since 1971, also. Since I started pumping, these areas have gone away, but I now have hard lumps of scar tissue from infusion sites & my continuous glucose sensor sites. Just have to work around them. I do notice that when I change my infusion site, if I get too close to scar tissue, by blood sugars tend to run higher because of worse absorption.

    Posted by Jaci Goodsell |
  5. What about discolorations? I am a 66 year old T1D. Almost since diagnosis I’ve had a brown area on my neck below my ear. It appears to be spreading to my jaw. It looks like “age spots,” but I have been told the one on my neck, especially, could be related to 53+ years with diabetes???

    Posted by Trudi Peters |
  6. Hi Trudi,

    You seem to have what is called Acanthosis nigricans. It’s very common in diabetes. As far as I know, the only treatment is improving glucose control. However, some skin creams can make it look better.

    We wrote about it here.

    Posted by David Spero RN |

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