If you’re on insulin or have ever been prescribed insulin, you were probably (hopefully!) told to switch up your injection site.

Whether you’re taking multiple daily injections of insulin or using an insulin pump and only changing out your injection site every few days, rotating your insulin injection site is critical to diabetes management.

Lipodystrophy & Lipohypertrophy

It may seem like just one more task to add to the list, but rotating your injection site is extremely important when it comes to insulin therapy. Among other reasons, so you don’t develop lipohypertrophy.

Lipohypertrophy is a type of lipodystrophy.

Lipodystrophy is—quite literally—a fat abnormality, or a disorder of the fat tissue. Lipoatrophy (a cratering or indenting of the fat tissue) and lipohypertrophy (LH) are the two most common types of lipodystrophy associated with people taking insulin.

Lipohypertrophy “is characterized by localized adipocyte hypertrophy and presents with soft dermal nodules at injection sites,” according to Endotext. It presents itself as abnormal, bulbous lumps of fat beneath the skin. It could be mildly painful or you may not feel a thing and think nothing of it.

But think about it—have you ever noticed a lump near your belly button? Has your doctor ever suggested you give a certain one of your injection spots a break? Most people that inject insulin regularly experience lipohypertrophy. We get busy and forget to rotate—it’s totally and absolutely normal!

But it can cause problems.

Lipohypertrophy Side Effects

The major side effect of lipohypertophy are those lumps that develop under the skin.

But another, more problematic one is insulin resistance or insulin rejection altogether. When you’re injecting insulin into these LH regions, its absorption rate is slowed down by those abnormal fat build-ups.

The fat lumps can also cause insulin pooling. When insulin doesn’t enter the bloodstream fast enough, it forms a “pool” in the area it was injected. In a short period of time, the pool of insulin is released all at once and a person’s blood sugar lowers rapidly.

All this variability in insulin absorption results in all sorts of blood sugar excursions, from the highs that come with the slow or null absorption rate to the insulin pooling that results in rapid (and unneeded) insulin release.

Reducing LH, on the other hand results in fewer frequent and unexplained low blood sugar, less glucose variability, reduced consumption of insulin, lower overall insulin cost, and better overall blood sugars!

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How to Prevent Lipohypertrophy

The best way to avoid developing lipohypertrophy in the first place is by rotating your injection sites!

This is the most effective way to treat and prevent LH. If you’re using insulin pens or syringes, rotate your injection site for each use. If you’re on a pump, do the same, but also make sure you’re not extending your wear over the recommended 3 days of use. 

Be aware that the majority of your skin is prime real estate for injection sites.

As someone who’s been injecting insulin into my body for over 23 years now, I take full advantage of about 85% of my skin: I inject my daily insulin doses in my bottom, my forearms, my upper arms, my chest, and basically anywhere else that isn’t my stomach or thighs (I used up that real estate long ago).

Find alternative and different places on your body that work for you! Meaning, quite simply, places that don’t hurt upon injection and dosing.

Ways to lessen the pain? Opt for smaller needles! If you’re using insulin pens or syringes, you have both pen and syringe options. Similarly, if you use an insulin pump, choose the infusion sets that have the smaller needle.

Changing out your needles (if you’re on multiple daily injections) is also helpful. Studies have shown a correlation between needle reuse and lipohypertrophy.

Also keep in mind, if you’ve been injecting at the same site for a while and then switch to new areas, you may need (a lot) less insulin than you’re currently taking. This is a great thing! But do make sure you’re keeping tabs on your blood sugars as you’re moving around sites.

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If you do feel hardness or bumps being formed from injection, it is absolutely best to completely avoid these areas so they can adequately heal.

Depending on the degree of damage, you should avoid the area for 2-3 months (or more). Over the course of those 2-3 months, you can feel the areas to see how the lipohypertrophy is softening and feeling more normal (no lumps or pain).

Sometimes, though, the damage is done and you simply shouldn’t (can’t) inject in these areas anymore. In my case, I can no longer inject in most of my abdomen. And that’s OK! I’ve got plenty more where that came from ;) And so do you!