Lipohypertrophy, the rubbery thickening that develops where insulin is injected repeatedly into the same area, is common and often missed. Insulin absorbed from these lumps is slower and less predictable, which produces unexplained highs, unexpected lows and steadily rising doses.
Inspect and palpate the abdomen, thighs and arms with the patient lying flat; the lumps are often easier to feel than to see. Ask about needle reuse and whether the patient favours one spot because it hurts less. Rotating sites and using fresh needles often stabilises glucose, and the dose may need to fall when injections move to healthy tissue.
- Palpate all injection sites at least once a year and whenever glucose becomes erratic.
- Ask about needle reuse and favourite injection spots.
- Teach a rotation pattern across and within sites.
- Warn that moving injections to healthy tissue can increase absorption, so watch for hypoglycaemia.
- Check sensor and pump cannula sites in the same way.
Why it matters
A dose increase for a technique problem can turn into hypoglycaemia once the patient starts injecting into healthy skin.
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