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Lipohypertrophy

1 Sites should be inspected and
any abnormalities documented
by the HCP within the
individual’s care plan. At a
minimum, each site should be
examined annually (preferably
at each visit for children).
If lipohypertrophy is already
present the sites should be
monitored at every review.
(41,138)

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2 Individuals should be taught
to examine their own injection
sites and how to detect
lipohypertrophy. (41,138)

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3 Using various available tools such as making two ink marks at opposite edges of the lipohypertrophy allows the lipo to be measured and its size recorded for long-term follow up. If visible the area of lipohypertrophy could also be photographed for the same purpose.

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4 Individuals should be advised
(and rationale explained)
not to inject into areas of
lipohypertrophy until abnormal
tissue returns to normal (which
can take months to years).
(139,140)

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5 Switching injections from areas of lipohypertrophy to normal tissue often requires a decrease of the dose of insulin injected. The amount of change varies from one individual to another and should be guided by frequent blood glucose measurements. (50,140)

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6 Caution is needed; too great a reduction in dose could lead to an increased risk of Diabetic Ketoacidosis in people with Type 1 Diabetes. However, too small a reduction could result in hypoglycaemia.

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7 The best current preventative and therapeutic strategies for lipohypertrophy include rotation of injection sites with each injection, and non-reuse of needles. (136,137,139,141-143)

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Lipoatophy, although very rare, is a wasting of the subcutaneous tissue at injection sites. Injecting into these sites should be avoided.

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Palpable lipohypertrophy: normal skin (fingertips close together) and lipohypertrophic tissue (fingertips spread apart). Photograph courtesy of Lourdes Saez-de Ibarra and Ruth Gaspar, Diabetes Nurses and Specialist Educators from La Paz Hospital, Madrid, Spain.

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Sometimes the “lipo” can have the appearance of a tense, shiny area as on the leg of this 19-year old man. NB: when you see a shiny, inducted area at an injection site, SUSPECT “LIPO”

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Sometimes the “lipo” can have the appearance of a tense, shiny area as on the leg of this 19-year old man. NB: when yousee a shiny, inducted area at aninjection site, SUSPECT “LIPO”

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29 year old man said: “it hurts less there”.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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