By Melanie Teslik, BC-ADM, CDE, MS, RN
As we continue to increase the use of technology in diabetes care and transition to pumps and CGM with shorter needles, one major issue lingers: have we forgotten about lipohypertrophy?
Lipohypertrophy, the thickening of tissue around injection sites, is still a major issue for people with type 1 or type 2 diabetes. Studies show that as many as 62% of your clients might be affected. However, when I mention it to others, many individuals look at me as if this cannot be a problem with current technology. Unfortunately, that’s simply not true. As diabetes care and education specialists, we must understand how to inspect and palpate injection sites, and work with clients to minimize risk.
The greatest complication from lipohypertrophy is the erratic absorption of insulin when the individual injects into affected areas. Depending on the amount and type of insulin used, absorption will be negatively impacted if injection continues without alternating sites. For those using long-acting insulins, it can remain at the site for even longer periods of time, further enhancing potential lipohypertrophy.
What You Can Do to Minimize Risk
When clients arrive for their appointment with glycemic variability, many providers will adjust the insulin dose immediately. However, when sites are simply rotated, there may be no need to adjust insulin. In fact, many times these same individuals will experience hypoglycemia when using alternate sites because absorption has been improved.
The first step with any client should be to examine injection sites to see if they have developed lipohypertrophy. Examination of injection sites through palpation and inspection often finds the cause is from continuous injections at the same site or side of the body. Talk with them and find out why they might be using the same site.
We need to remember to examine site selections at every visit and work with clients to understand their reasons for limiting site selection, because the consequences are very real.
Clients will most often say they do this because “it doesn’t hurt” due to scar tissue in that area. Let them know that there are steps we can take to minimize pain when rotating sites. As diabetes care and education specialists, we have learned to use the shortest needle possible. While this does not solve the problem, it does encourage the client to try alternate sites since it hurts less or not at all.
Our clients are at greater risk for developing lipohypertrophy than ever before. We need to remember to examine site selections at every visit and work with clients to understand their reasons for limiting site selection, because the consequences are very real. There are only so many areas for a client to inject on their body, so to lose one site places the remaining areas at risk.
For more information on insulin injection techniques, including free tip sheets for your clients, visit DiabetesEducator.org/InsulinInjection.
ADCES Perspectives on Diabetes Care
The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.
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