Lipohypertrophy causes unexplained highs and lows

Do you have unexplained high or low blood glucose?  Do you find that your blood test results aren’t reflecting your effort and hard work?  If you have lived with type 1 or insulin dependent type 2 diabetes for many years,  you may be suffering from a complication of injecting insulin called lipohypertrophy, also called “lipo”.

What is this lipohypertrophy?

Many people with diabetes who inject insulin don’t know what lipo is because their medical team may have neglected to mention it in their review of self-management care.  It’s important to understand lipohypertrophy because it can cause variable insulin absorption resulting in unexplained high and low blood glucose (bg), and really cause problems, including a visit to the ER.

Lipo is a lump or swelling just under the skin in areas where insulin has been injected over and over again.  Fat and scar tissue accumulate in these areas and can be rubbery.  Lipo is usually found most often in the abdomen. Essentially the tissue is damaged and sensation in the area may be lost.  If you find you favour injecting in areas where there is less pain, this may be a sign that there is damaged tissue or lipo in that area.  Injecting insulin into areas of skin complicated by lipo impacts absorption, where the insulin takes much longer to be absorbed or very fast, and unexpectedly.

Lipohypertrophy is associated with longer duration of injecting insulin and is caused by one or a combination of the following behaviors:

• Failure to rotate injection sites (including insulin pump sites).
• Needle reuse (especially reusing needle >3 times).
• A low/lower body mass index (BMI).
• Use of human insulin versus analogue insulin.

To compensate for lipo, people often need to increase their total daily dose of insulin and are at greater risk for unexplained hypoglycaemia, and high blood glucose or diabetic ketoacidosis (DKA).  Variability of BG over time can lead to more serious complications.

Early detection and timely correction of injection techniques are critical for reversing the complication.  Identifying areas at risk, and discussing and having a healthcare provider look over injection sites should be a part of a diabetes care plan.  Steps for avoiding the complication and reversal include:

• Coming up with an injection site rotation plan and sticking to it.
• Using fresh needles.
• Giving about an inch between injection sites.
• Avoiding areas where lipo has been identified – usually (but not always) the tissue will heal.
• Continue to review injection sites with your medical team.

Awareness and management of lipohypertrophy among both healthcare providers and people with diabetes is key for successful insulin therapy.