I have learned to love my job for many different reasons. The main one however, is that I can be a part of people’s diabetes journey. This may include me using such phrases as, “Excuse me, could you please lift your shirt and let me feel your belly?” “Now, how about you pull down those pants so we can see what’s been happening down there?” Please don’t be alarmed—these are phrases that I now find myself saying on a regular basis at work. I have learned from many people living with diabetes that along their personal journey there are unique challenges when faced with injecting/pumping insulin. Today I plan to expose one of the most unrecognized and consequently one of the most significant complications when using insulin, lipohypertrophy.
Lipohypertrophy is a difficult, socially awkward word to say. Trust me. You can break it down to “lipo-hy-per-tro-fi” or just say “lipo” and anticipate that most people will know what you mean. It is defined as a thickened area of skin, which may appear or feel lumpy, surrounding the area where insulin injections are given. They can be small hard lumps or large rubbery lumps under the skin. These lumps can sometimes only be felt upon a physical examination or they can be so obvious that they are seen from across the room. These lumps inhibit the absorption of insulin and therefore make achieving healthy blood glucose control very difficult.
Lipohypertrophy is one of the major causes of unexplained highs and lows. You know these times quite well, I’m sure. Things are going along like they would normally and then “bang” a series of unexplained lows, followed or preceded by some suspicious highs. When I think of all time and effort that the person with diabetes, the caregiver and/or myself have spent trying to figure out insulin doses, I feel slightly embarrassed. I will be honest; I wasn’t always so quick to get the patient’s pants off when they came to see me with their erratic blood sugars. There is the obvious “awkwardness” for some surrounding a physical examination of injection/pump sites. This may be part of the reason that it is not done on a regular basis by many healthcare providers. However, when I pick up on someone’s hesitation for me to examine their injection sites I remind them that, “The dose is irrelevant if the insulin is not getting absorbed properly.”
The good news is that you can perform a couple simple techniques to reduce the amount of lipohypertrophy you will experience when injecting insulin. The following two actions have been proven to help:
- Site Rotation: You need to change your pump insertion or insulin injection site regularly. This is usually best accomplished by using some sort of pattern or grid. By using your “prime real-estate” regularly you are shortening the amount of time that it will be a reliable injection/insertion site. If you don’t feel anything in a favorite site of yours, it’s a good sign that it’s unhealthy tissue. You can visit this link to the Forum for Injection Technique (FIT) for useful information on rotation techniques.
- Needle Reuse: I know that some people will be rolling their eyes at this one, but it’s true! Insulin needles are intended for single use. The chance of getting lipohypertrophy dramatically increases after two uses. They do dull after each use, which contributes to the incidence of lipohypertrophy.
If you are reading this and suddenly feel as though that lumpy belly may be more suspicious than you initially thought, fantastic! You have just completed the first step in recognizing and treating your lipohypertrophy. I know that standing in front of a full-length mirror with your shirt pulled up high and your pants tucked under your lower abdomen isn’t easy. On a personal note, I suggest that you do it when your children are not around as we all know that they have an incredible ability to be brutally frank during these vulnerable moments. Regardless, it’s very important to look at and feel your injection sites on a regular basis. If you suspect lipohypertrophy, you need to stop injecting in the affected area until the lipohypertrophy subsides; it can take weeks to years. You may require a dose reduction when injecting into healthy skin (new sites), so be cautious when using a new site. Contact your healthcare provider for more information.
In summary, this sneaky complication from injecting insulin can be really messing with your blood sugar control. Let’s use lipohypertrophy as one of the first things that we ask ourselves when the blood glucose numbers have been a little off. Being aware of the condition will not only make you more successful at achieving your desired blood glucose levels, but hopefully relieve some of the guilt that erratic control can cause. Besides, the first time that you ask your healthcare provider to examine your injection sites for lipohypertrophy you will feel like you are taking control of your diabetes journey.
—Trish Byrne RN, CDE