Lipohypertrophy and Insulin: An Old Dog That Needs New Tricks

Objective: To review the current status of practical knowledge related to insulin-associated lip-ohypertrophy (LH) d an accumulation of fatty subcutaneous nodules commonly caused by repeated injections and/or infusions of insulin into the same site.Methods: Review of published literature with additional contributions from leading multidisciplinary experts with the emphasis on clinical aspects including pathophysiology, clinical and economic consequences, diagnosis, prevention and treatment. Results: LH is the most common dermatologic complication of insulin therapy. Risk factors for the development of lipohypertrophy include repeated delivery of large amounts of insulin into the same location over time, repeated injection trauma to the skin and subcutaneous tissue, and multiple injections using the same needle. Subcutaneous insulin injection in skin areas with lipohypertrophy is associated with reduced pain; however, this problem can interfere with insulin absorption, thereby increasing the likelihood of glucose variability, hypo-and hyperglycemia when a site is changed. Modern visualization technology of the subcutaneous space with ultrasound can demonstrate lip-ohypertrophy early in the course of its development.Conclusions: The physiological and psychological consequences of developing insulin lipohyper-trophy can be prevented and treated with education focusing on insulin injection techniques.& COPY; 2023 AACE. Published by Elsevier Inc. All rights reserved.