Insulin related lipohypertrophy in hemodialyzed diabetic people. Lipohypertrophy remains a frequent complication of insulin therapy irrespective of the insulin source and. Lipohypertrophy is a lump under the skin caused by accumulation of extra fat at the site of many subcutaneous injections of insulin. In this study, we assessed the impact of injection technique it education, including use of a 4mm pen needle on insulin. To use continuous glucose monitoring cgms to compare glucose profiles in people with type 1 diabetes following injection of insulin into an area affected by lipohypertrophy vs. Lipodystrophy, lipohypertrophy, lipoatrophy the information in the brief version is excerpted directly from the fulltext guidelines. Insulin, administered subcutaneously, may cause either lipoatrophy or lipohypertrophy. In a crosssectional study, we evaluated the predictors of lipohypertrophy in 372 type 1 diabetes patients mean age 17. Lipohypertrophy has been a recognized complication of insulin therapy for many years, yet research shows that its prevalence in insulin injecting patients with diabetes remains high.
Its common in people with insulin dependent diabetes because repeated injections can cause fat to build up. The brief version is a compilation of the tables and. Lipohypertrophy, or just lipo, is a common complication, affecting anywhere from about half to threequarters of people who inject insulin. Pdf lipohypertrophy a complication of insulin injections. Lipohypertrophy has been suggested as an outcome of lipogenic action of insulin andor injectionrelated tissue trauma.
Research unexplained hypoglycaemia and large glycaemic. Aade pro tips american association of diabetes educators. Hearnshaw the leicester royal infirmary, leicester le5ww, uk. Lipohypertrophy is a medical word for fatty lumps which appear under the skin in some people taking insulin injections. Lipohypertrophy in insulintreated diabetes diabetes on the net. Clinical implications of lipohypertrophy among people with.
Benign acanthosis nigricans an is most often related to insulin resistance and presents as asymptomatic, hyperpigmented, velvety plaques on the neck, axillae, groin, and other body folds. It may be unsightly, mildly painful, and may change the timing or completeness of insulin. It may be the result of an immune response or the use of less than pure insulin. They can vary in size and shape from that of a small garden pea to a tennis ball. Lipohypertrophy the neglected area of concern in the. Lipohypertrophy among insulin treated patients jameel nasser, md, msc fathiya hammad, md ahmed omran, md, msc objective. Lipohypertrophy lh at insulin injection sites is a common but preventable complication in type 1 diabetes mellitus t1dm. Eight patients with type 1 diabetes underwent 72 h of cgms while following a standardized diet and injecting all insulin. Insulin injection, lipodystrophy, lipohypertrophy, injection rotation, insulin consumption, costs. Pdf lipohypertrophy the neglected area of concern in. With the arrival of human insulin, lipoatrophy has decreased dramatically, becoming a rare problem in clinical practice. Sometimes it may take a year before the fatty lumps disappear and some cases fat suctioning procedure has been used. Objective to examine the usefulness of liposuction surgery on diabetic patients with lipohypertrophy.
Learn about lipohypertrophy and what you can do to avoid it. Lipohypertrophy a complication of insulin injections. What most people think is scar tissue is actually insulin lipohypertrophy localized hypertrophy of subcutaneous fat at insulin injection sites, caused by the lipogenic effect of insulin. Detailed advice on how to inject to avoid lipohypertrophy or lipos has also been issued. An effective intervention for diabetic lipohypertrophy.
Pdf lipohypertrophy has been suggested as an outcome of lipogenic action of insulin andor injectionrelated tissue trauma. Lipohypertrophy occurs because patients inject the same site day after day. Insulin is secreted by the pancreas in a glucosedependent. The following study was instigated by the observation of two diabetic patients with extensive areas of lipohypertrophy at the site of insulin application in one of whom lipomata were present also elsewhere on the body. To our knowledge, this is the first report of insulin induced lipohypertrophy with detailed histological examinations. Original article injection sites lipohypertrophy among 736. Lipoatrophy and lipohypertrophy were the most frequently reported local complications of conventional insulin therapy. Lipohypertrophy is thought to occur because of repeated stimulation of adipocytes by the injection of insulin, probably due either to traumatic injury caused by needles or to the direct effects of insulin. Lipohypertrophy in hiv clients lead to truncal obesity and also affects the insulin leading to complication of diabetes in hiv clients. The problem for the patient is that the injection of insulin into a site of lipohypertrophy, although painless, may lead to erratic absorption of the insulin. Lipohypertrophy lh occurs in subcutaneous tissue as a result of the lipogenic effect of repeated insulin exposure 1, 2. The primary treatment for lipohypertrophy is to leave it alone for weeks or month. For example, lipoatrophy or lipohypertrophy can develop at the site of insulin injections. Before the advent of recombinant human insulin, insulin induced lipoatrophy was a common problem among insulin.
Lipohypertrophy is present at the injection sites of many people who inject insulin. The effect of lipohypertrophy at injection sites on insulin absorption has been studied in 12 insulin dependent diabetic patients. Early reports following the introduction of highly purified insulins suggested a reduction in the frequency of lipohypertrophy. 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. Insulin injectable therapy is an easy process and so the side effect of injecting insulin in the same area of the body again and again leads to development of a thicker subcutaneous adipose tissue which is not a pleasant outcome. Insulin induced lipohypertrophy is the loss of subcutaneous fat at the site of insulin injection. Best practice guideline to support correct injection. Lipohypertrophy and lipoatrophy complicating treatment. Research design and methods we treated a diabetic patient who suffered from severe localized thigh lipohypertrophy.
Original article injection sites lipohypertrophy among 736 patients with type 2 diabetes of differentgrade hospitals feifei li, shimin fu, zhiping liu, xiurong liu, chunjuan hu, qifu li department of. Longterm use of insulin may cause lipodystrophy at the site of repeated injection. Lipohypertrophy, referred to as lipo for short, is a thickened area of tissue that can grow and develop over time in the subcutaneous fat layer where repeated injections of insulin are given. Before the development of purified insulin in the 1970s, lipoatrophy was a common complication of insulin therapy 1,2.
Pdf lipohypertrophy and lipoatrophy of injection sites was a major problem with the old impure insulins. Lipohypertrophy treatment, definition, pictures, causes. The fat cells enlarge and proliferate resulting in. The management of lipohypertrophy in diabetes care. Supplementary material 1 pdf 532 kb 532k, pdf acknowledgements. Lipoatrophies are considered an adverse immunological side effect of insulin. The full text of this article is available in pdf format. Insulin may cause sodium retention and edema, especially as metabolic control is improving. Lipohypertrophy and lipoatrophy complicating treatment with highly purified bovine and porcine insulins paul g. Lipohypertrophy a complication of insulin injections 10. Teaching injection technique to people with diabetes. New insulin safety leaflet from trend uk diabetes uk.
They were advised not to inject insulin into these sites, to rotate injection sites and reduce the dose of insulin by 10%. If you inject into them, your insulin may not work properly. Dermatological complications of insulin therapy in. To evaluate insulin injection practice, prevalence and risk factors of lipohypertrophy lh among insulin. Localized acanthosis nigricans at the site of repetitive. Insulin injectable therapy is an easy process and so the side effect of injecting insulin in the same area of the body again and again leads to development of a thicker subcutaneous adipose tissue. A 55yearold man with a 31year history of type 1 diabetes mellitus presented for a routine clinical evaluation, his. Lipodystrophy is a disorder afflicting subcutaneous fat and can result in lipoatrophy or lipohypertrophy. People who need insulin are being reminded to inject at a 90 degree angle in either the upper outer thighs, upper outer buttocks and abdomen. Teaching injection technique to people with diabetes january 2017 for people with diabetes who take insulin or other injectable diabetes medications, the diabetes educator can teach evidencebased. The dangers and difficulties of insulin lipohypertrophy.
Lipohypertrophy lh is highly prevalent and is potentially harmful to insulin injecting patients. Unhealthy lumps and bumps called lipohypertrophy, or just lipo, can form under the skin of people who inject insulin. A team of diabetes educator nurses performed a clinical examination for evidence of lipohypertrophy. Diabetic lipohypertrophy delays insulin absorption diabetes care. Based on the history and clinical features, a diagnosis of insulininduced lipohypertrophy was made. Insulin injected into lipohypertrophic tissue lipos is poorly absorbed and can lead to hypoglycaemia or hyperglycaemia and the need for increasing. Lipohypertrophy, sometimes referred to a lipo, is a thickened rubbery area of fat tissue that can grow and develop in the subcutaneous fat where injections of insulin. Severe insulininduced lipohypertrophy successfully. Lipohypertrophy, sometimes referred to a lipo, is a thickened rubbery area of fat tissue that can grow and develop in the subcutaneous fat where injections of insulin are given. Prevalence and risk factors of lipohypertrophy in insulininjecting. Lipohypertrophies are thickened, rubbery lessions that develop over time in the subcutaneous tissue of many patients who inject insulin.
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