If you inject into them, your insulin may not work properly. 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. Lipohypertrophy a complication of insulin injections 10. Localized acanthosis nigricans at the site of repetitive. Teaching injection technique to people with diabetes. Insulin related lipohypertrophy in hemodialyzed diabetic people. The full text of this article is available in pdf format. Insulin is secreted by the pancreas in a glucosedependent. They can vary in size and shape from that of a small garden pea to a tennis ball.
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. Lipoatrophies are considered an adverse immunological side effect of insulin. Lipohypertrophy has been suggested as an outcome of lipogenic action of insulin andor injectionrelated tissue trauma. The fat cells enlarge and proliferate resulting in. New insulin safety leaflet from trend uk diabetes uk. Research unexplained hypoglycaemia and large glycaemic. A 55yearold man with a 31year history of type 1 diabetes mellitus presented for a routine clinical evaluation, his. It may be the result of an immune response or the use of less than pure insulin. Lipohypertrophy is a medical word for fatty lumps which appear under the skin in some people taking insulin injections.
Eight patients with type 1 diabetes underwent 72 h of cgms while following a standardized diet and injecting all insulin. For example, lipoatrophy or lipohypertrophy can develop at the site of insulin injections. To evaluate insulin injection practice, prevalence and risk factors of lipohypertrophy lh among insulin. 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. Lipohypertrophies are thickened, rubbery lessions that develop over time in the subcutaneous tissue of many patients who inject insulin. 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. 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. Hearnshaw the leicester royal infirmary, leicester le5ww, uk. Lipohypertrophy a complication of insulin injections. Lipohypertrophya complication of insulin injections.
Lipohypertrophy and lipoatrophy complicating treatment. To our knowledge, this is the first report of insulin induced lipohypertrophy with detailed histological examinations. 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. Lipohypertrophy is an abnormal mass of fat under the skin. Lipohypertrophy in hiv clients lead to truncal obesity and also affects the insulin leading to complication of diabetes in hiv clients. Learn about lipohypertrophy and what you can do to avoid it. 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. Lipohypertrophy is a lump under the skin caused by accumulation of extra fat at the site of many subcutaneous injections of insulin. Lipohypertrophy occurs because patients inject the same site day after day. Lipodystrophy is a disorder afflicting subcutaneous fat and can result in lipoatrophy or lipohypertrophy. The dangers and difficulties of insulin lipohypertrophy. Lipohypertrophy treatment, definition, pictures, causes.
In a crosssectional study, we evaluated the predictors of lipohypertrophy in 372 type 1 diabetes patients mean age 17. Diabetic lipohypertrophy delays insulin absorption diabetes care. The management of lipohypertrophy in diabetes care. Sometimes it may take a year before the fatty lumps disappear and some cases fat suctioning procedure has been used. 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. Pdf lipohypertrophy the neglected area of concern in. Lipohypertrophy, or just lipo, is a common complication, affecting anywhere from about half to threequarters of people who inject insulin. Detailed advice on how to inject to avoid lipohypertrophy or lipos has also been issued. Insulin, administered subcutaneously, may cause either lipoatrophy or lipohypertrophy. 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.
Lipohypertrophy is when fatty lumps appear on the surface of the skin and is a fairly common side effect of insulin. An effective intervention for diabetic lipohypertrophy. Before the development of purified insulin in the 1970s, lipoatrophy was a common complication of insulin therapy 1,2. 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. Research design and methods we treated a diabetic patient who suffered from severe localized thigh lipohypertrophy. Pdf lipohypertrophy has been suggested as an outcome of lipogenic action of insulin andor injectionrelated tissue trauma. Lipohypertrophy lh is highly prevalent and is potentially harmful to insulin injecting patients. 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. The effect of lipohypertrophy at injection sites on insulin absorption has been studied in 12 insulin dependent diabetic patients. Best practice guideline to support correct injection. Lipohypertrophy is defined an accumulation of subcutaneous fat tissue at a site where insulin has been injected continuously. Longterm use of insulin may cause lipodystrophy at the site of repeated injection.
Unhealthy lumps and bumps called lipohypertrophy, or just lipo, can form under the skin of people who inject insulin. Objective to examine the usefulness of liposuction surgery on diabetic patients with lipohypertrophy. The word means fat lipo, too much hyper, gain trophy. The primary treatment for lipohypertrophy is to leave it alone for weeks or month. Insulin injection, lipodystrophy, lipohypertrophy, injection rotation, insulin consumption, costs. With the arrival of human insulin, lipoatrophy has decreased dramatically, becoming a rare problem in clinical practice. Pdf lipohypertrophy and lipoatrophy of injection sites was a major problem with the old impure insulins. Early reports following the introduction of highly purified insulins suggested a reduction in the frequency of lipohypertrophy. 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.
Insulin injected into lipohypertrophic tissue lipos is poorly absorbed and can lead to hypoglycaemia or hyperglycaemia and the need for increasing. Lipohypertrophy the neglected area of concern in the. Original article injection sites lipohypertrophy among 736. Supplementary material 1 pdf 532 kb 532k, pdf acknowledgements. Lipohypertrophy lh at insulin injection sites is a common but preventable complication in type 1 diabetes mellitus t1dm. Lipohypertrophy and lipoatrophy complicating treatment with highly purified bovine and porcine insulins paul g. Concurrence of lipoatrophy and lipohypertrophy in children. 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. Pdf lipohypertrophy a complication of insulin injections. Based on the history and clinical features, a diagnosis of insulininduced lipohypertrophy was made. Insulin may cause sodium retention and edema, especially as metabolic control is improving.
Lipodystrophy, lipohypertrophy, lipoatrophy management. 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. Lipoatrophy is the breakdown of adipose tissue at the insulin injection site causing a depression in the skin at the injection site and occasionally at distant sites also. Dermatological complications of insulin therapy in. Lipoatrophy and lipohypertrophy were the most frequently reported local complications of conventional insulin therapy. Lipohypertrophy lh occurs in subcutaneous tissue as a result of the lipogenic effect of repeated insulin exposure 1, 2. Before the advent of recombinant human insulin, insulin induced lipoatrophy was a common problem among insulin. They were advised not to inject insulin into these sites, to rotate injection sites and reduce the dose of insulin by 10%. Lipodystrophy, lipohypertrophy, lipoatrophy the information in the brief version is excerpted directly from the fulltext guidelines. Lipohypertrophy remains a frequent complication of insulin therapy irrespective of the insulin source and. Aade pro tips american association of diabetes educators. Prevalence and risk factors of lipohypertrophy in insulininjecting. A team of diabetes educator nurses performed a clinical examination for evidence of lipohypertrophy. Severe insulininduced lipohypertrophy successfully.
In a crosssectional study the frequency of insulin induced lipohypertrophy at injection sites was assessed in 223 type 1 and 56 type 2 diabetic patients. Lipohypertrophy in insulintreated diabetes diabetes on the net. Lipohypertrophy among insulin treated patients jameel nasser, md, msc fathiya hammad, md ahmed omran, md, msc objective. In this study, we assessed the impact of injection technique it education, including use of a 4mm pen needle on insulin.
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. Insulin induced lipohypertrophy is the loss of subcutaneous fat at the site of insulin injection. It may be unsightly, mildly painful, and may change the timing or completeness of insulin. The brief version is a compilation of the tables and.
Clinical implications of lipohypertrophy among people with. Lipohypertrophy is present at the injection sites of many people who inject insulin. 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. Insulinrelated lipohypertrophy in hemodialyzed diabetic.
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