Lipohypertrophy — skin-related complication of insulin therapy

Abstract

The number of diabetes patients treated with insulinhave substantially increased in recent years, partlydue to steadily growing incidence of type 1 diabetesand partly because of a common practice of the earlystart of insulin in the treatment of patients with type 2 diabetes but also due to increase in the. Weightgain and hypoglycemia are typical side effects ofinsulin therapy. Long term use of insulin is alsoassociated with skin related local complications likeinfections, edema, allergy and subcutaneous fattissue lesions (lipodystrophy).Lipohypertrophy is the most common cutaneouscomplication of insulin therapy, characterized byswelling of fatty tissue around insulin injection sites.It occurs mainly in type 1 diabetes patients withprevalence 20–50%. The main risk factor is using thesame skin region for insulin injections, and othersinclude age, long duration of diabetes, low bodymass index, young age and use of the abdominalarea for injections. Continuation of insulin injections at lipohypertrophic areas may significantly reduceinsulin absorption and results in the increase of bloodglucose.To prevent lipohypertrophy a patient should be educatedto regularly change injection sites, and it is vital toregularly assess them during medical check-ups.Once lipohypertrophy develops, changing injectionsite and/or — if possible — switching from humaninsulin to insulin analog. If that strategy fails,liposuction or surgical resection may be indicated.