Sure what’s the harm with a little Lipo

We all develop some bad habits, we have our favorite or handy injection sites and we tend to stick with them. Sometimes it depends on what we are wearing or where we are. Sure what’s the harm with a little Lipo anyway I hear you say ….. well here’s the info on Lipohypertrophy

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.

What’s the issue?

Lipos can be unsightly but more often than not they go unnoticed.

The main concern is that lipos cause insulin to be absorbed unpredictably.  This can result in poor day-to-day control, higher blood glucose levels and the needle for more insulin.  It can also lead to hypoglycaemic episodes (hypos).

Finding a lipo can be a concern, but don’t worry.  Simple changes to your injection technique will help, and if you can avoid injecting into the area, many lipos may reduce in size or disappear over time, but you should always seek advice from your nurse or doctor before using these sites again.

Did you know? Shorter pen needle will allow you to rotate your injection sites more widely and even move to different injection sites with less chance of an intrmuscular injection which can sometimes lead to hypos.

Step 1 – PreventRotate your injection sites, use injection zones, never reuse needles

Lipos generally form when you inject into the same small area.  To minimise the risk of lipos developing you need to rotate your injection sites.

This can be done by dividing your injection sites into zones.  By using one zone at a time and moving around within that zone you can avoid reinjection into one site.

This is how you do it:

  • Divide the abdomen injection area into 4 zones
  • Divide each thigh and buttock injection area into four zones (two each side)
  • If using the arm* treat as one zone on each area
  • Number the zones using the illustrations in this guide – you will systematically move from zone to zone in sequence
  • Begin in the first zone – imagine a clock face over each zone and start at 12 o’clock for your first injection
  • For each new injection move around the clock face
  • Start a new zone each week i.e. every Monday

Important

Each new injection must be at least 1 cm away from the previous one.

By following this technique (even if you only use the abdomen and thigh areas), each individual injection insertion point will only be used once every eight weeks.  This will help reduce the risk of lipo development.


Step 2 – DetectIt is important to make detection and identification of lipo an important part of your injection routine.

If you find any lumps, bumps or swellings in your injection sites, report them to your nuse or doctor immediately.

These steps will help you to detect lipos:


  • Remove any restrictive clothing from over or near the areas where you inject
  • Stand in front of a full length mirror
  • With your finger and thumb gently lift skin and fat tissue folds, and squeeze together.  Repeat this over the entire injection area
  • If the tissue is healthy your finger and thumb will easily squash the soft fat tissue with little or no resistance
  • If lipos are present you will feel a ‘rubbery’ like tissue resistance between your finger and thumb
  • Lipos vary in size, from as small as a pea to larger than a tennis ball
  • Repeat this skin fold check on all of your injection site areas regularly

Your nurse or doctor will teach you how and when to check for lipos.  Some nurses have a lipo detection teaching model and educational materials which can help with self-checking.

The use of a lubricant like a body lotion or any skin oil will help your fingers detect any abnormality in the fatty tissue.


Step 3 – ProtectIf you find you have lipohypertrophy do not be concerned, however, it is very important to speak with your nurse or doctor before making any changes to your injection technique or insulin dose.

They may want to examine your injection sites, and if they confirm you have a lipo, you will need to stop injecting into the site for a period of time.  They will also advise you on any changes to your injection technique, insulin dose and how best to switch to a new injection site.

  • Often, your dose of insulin will be reduced.  Your nurse or doctor will advise you how to do this
  • You will need to frequently check your blood glucose levels when changing sites and adjust your insulin dose accordingly
  • Fat layer thickness is variable within the same injection site.  Therefore, when moving to a new injection zone this can lead to a risk of injecting insulin too deep into the muscle layer which can lead to hypos – you may benefit from shorter needles without the need for a lifted skinfold
  • You should not inject into a lipo area again, unless advised it’s safe to do so by your nurse or doctor

Don’t Worry!

Now you know all about lipohypertrophy – you can take all the necessary steps to prevent it and manage it!

Did you know: reusing needles can make injections more uncomfortable and painful.  Needles are designed to be used once only and may become blocked or damaged if used many times.  Reuse of needles has also been implicated in development of lipos.  So make sure that you use a brand new needle each time.

All of the above information is from BD can be found on the BD website

*IMPORTANT INFORMATION*
For those who think diabetes is caused by an unhealthy lifestyle let me clarify a couple of things.

I have type 1 diabetes. It’s an autoimmune disease. Nothing I did, or didn’t do caused it and nothing I do will cure it. There’s is currently no cure for Type 1 diabetes.

Type 1 Diabetes happens because our own antibodies attack and destroy an organ in the body. it’s an autoimmune response where antibodies that normally fight disease mistake a part of our body
(the pancreas in this case) as foreign and attack to destroy it.
When those antibodies attack the insulin-producing islets in the pancreas we stop producing insulin so we need to inject or pump it.

Without insulin a person with type 1 diabetes would die. At present it is not known what causes this to happen, and there is no cure.
A person with Type 1 diabetes MUST inject or pump insulin to stay alive.

There are many factors that contribute to a diagnosis of Type 2 diabetes so pre judgment of a lifestyle choice is unfair at very least.
A person with Type 2 diabetes, while still producing their own insulin for various reasons their body cannot use it correctly or efficiently.
These people are generally treated with oral medications and sometimes with insulin injections.

Davina Lyon

 Co-Founder of Diabetes T One & A Diabetes Life

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