If you give yourself insulin injections, you might eventually see or feel hard, lumpy areas under the skin. This condition is called lipohypertrophy, and noticing it for the first time can be worrisome or even downright scary. What is lipohypertrophy? What causes it? And can it be prevented?
Lipohypertrophy occurs when fatty lumps appear under the skin. Initially, lipohypertrophy can start as thickened skin; over time, the following characteristics may appear:
Sometimes lipohypertrophy is present without lumps; the area is flat, in other words. A healthcare provider can confirm the presence of lipohypertrophy by deeply palpating the skin. Ulltrasound can also pick up lipohypertrophy.
Symptoms, however, don’t include pain, redness or bruising. If you have these symptoms, you could have an infection or an injury, so be sure to let your healthcare provider know.
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The main cause of lipohypertrophy is giving multiple injections in the same area over an extended period of time. Since insulin is an “anabolic” hormone (meaning, it promotes the storage of glucose, amino acids and fat), it can lead to the buildup of fatty tissue at the injection site.
People with type 1 and people with type 2 diabetes who inject insulin are at risk for developing this condition. In one study, published in the journal Diabetes in 2019, 62% of the subjects had lipohypertrophy. Another study in the Journal of Caring Sciences in 2018 found that the prevalence of this condition in patients with type 2 diabetes was 44%.
Since lipohypertrophy occurs as a result of repeated injections into the same area, anyone who administers an injection subcutaneously (meaning, injecting into the tissue area just under the skin) is at risk. If you use a non-insulin injectable medication, such as a GLP-1 receptor agonist (Victoza, Byetta, Bydureon, Tanzeum, Trulicity, Adlyxin, Ozempic, Rybelsus) or if you insert an insulin pump infusion set or a CGM sensor, you can be at risk for lipohypertrophy, too.
Other risk factors for lipohypertrophy include:
You may not be happy to see or feel lumps under your skin (not many people would be!). But appearance aside, lipohypertrophy can cause insulin to be absorbed erratically and unpredictably. As a result, you may notice more high and low blood sugars despite taking your insulin as prescribed, watching your carbs, staying active, etc. You may end up having to take more insulin, too. Managing diabetes, then, can become a whole lot harder.
Fortunately, those lumps and bumps do get smaller and will go away. But be patient, as it can take many weeks or even months to notice an improvement. In extreme cases, areas of lipohypertrophy can be surgically removed. Studies also show that liposuction may be useful, as well.
The answer is yes! How? Rotate, rotate, rotate — your injection sites, that is. Remember that using the same injection site, say, the left side of your abdomen, all the time is what causes lipohypertrophy in the first place. By switching things up, you can prevent this from happening.
Your healthcare provider or diabetes educator will likely talk with you about “rotating your injection sites.” Common injection areas include:
Rotate your injection site with every injection, and inject at least one finger-width away from your previous site. Try not to use the same injection site more than once every four weeks.
For more information about insulin injections and site rotation, download the Insulin Injection Know-How sheet from the Association of Diabetes Care & Education Specialists here.
Finally, at each regular office visit, ask your provider to check for areas of lipohypertrophy, especially if you notice more erratic blood sugar levels.
Want to learn more about insulin? Read “What Does Insulin Do?” “Insulin: What You Need to Know” and “Insulin Basics.”
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