Lipohypertrophy: A Hidden Diabetes Complication

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“Rotate your injection sites.” Most of us have heard this advice, but do we really understand why it’s important?

You may be aware that if you inject insulin into the same spots repeatedly, you’ll inevitably develop lumps of unhealthy fat under the skin. This is called lipohypertrophy, and it sounds like reason enough to take rotation seriously, but you may be surprised to learn that lipohypertrophy can result in a host of major negative consequences: more frequent hypos, rollercoastering blood sugars, increased insulin needs, and rising A1C.

And even many health care professionals don’t understand how common it is: it may affect more than half of all people injecting insulin. Even if you don’t have visible lumps on your body, you may have some measure of lipophypertrophy, and you may be suffering its insidious consequences without even knowing it.

What Is Lipohypertrophy?
To understand the problem and its scope, we spoke to Lori Berard, an expert in the subject.

Berard has been involved in diabetes research and care for over 30 years, as a registered nurse and diabetes educator. For the last ten years she has chaired the Canadian Forum for Injection Techniques, a position from which she aims to raise awareness around the problem of lipohypertrophy.

Insulin acts as a growth factor, and when it is repeatedly injected into the same area, it can result in localized fat growth. “Insulin acts basically like a steroid to increase the size of the subcutaneous tissue. The individual fat cells are being fueled,” Berard states. Repeated injections (and needle re-use) increase the trauma to the area.

The real problem comes when patients continue to inject insulin into these unhealthy fat deposits. Insulin injected directly into the lumpy fat is both less effective and less predictable. Less predictable insulin action increases glycemic variability – unexpected highs and lows – and less effective uptake prompts the patient to use more and more insulin, which itself increases the amplitude of variability. It’s a vicious cycle, and in many patients the phenomenon may be responsible for a great deal of the frustrating unpredictability that makes diabetes so difficult to manage from one day to the next.