The New England Journal of MedicineInsulin-Induced Lipohypertrophy

The formation of subcutaneous masses due to repeated insulin injections, known as insulin-induced lipohypertrophy, highlights the need for careful injection-site management to optimize glycemic control and avoid complications.

A 65-year-old man with type 2 diabetes experienced hyperosmolar hyperglycemic state following an increase in his insulin dose. Physical examination revealed insulin-induced lipohypertrophy, a localized lipodystrophy caused by repeated insulin injections at the same site. This condition can interfere with insulin efficacy and result in erratic blood sugar levels. Proper education on injection-site rotation and regular examination for such complications are crucial for effective diabetes management.

Key Points:

• A 65-year-old man with type 2 diabetes was admitted with hyperosmolar hyperglycemic state after an increase in his insulin dose due to poor glycemic control.
• The patient exhibited confusion and sarcopenia during physical examination.
• Notable findings included rubbery, subcutaneous masses on either side of the umbilicus, diagnosed as insulin-induced lipohypertrophy.
• Insulin-induced lipohypertrophy is a localized lipodystrophy resulting from repeated subcutaneous injections at the same site.
• This condition can lead to decreased insulin efficacy and erratic glycemic levels.
• Lipohypertrophy can be challenging to detect in patients with obesity, but palpable masses are usually found during abdominal examinations.
• It is essential for patients using subcutaneous insulin to undergo regular examinations for injection-site complications during clinic visits.
• Patients should be counseled on the importance of rotating injection sites to promote healing and prevent lipohypertrophy.
• The patient’s glycated hemoglobin level was notably high at 11.4% (reference range, <7).
• After 48 hours of insulin and intravenous fluid treatment, the patient’s hyperosmolar hyperglycemic state resolved.
• He was discharged with proper instructions on the administration of subcutaneous insulin.

Injection site complications are incredibly common; lipohypertrophy has an estimated prevalence of between 14.5 and 88% of insulin-dependent people with diabetes. (Diabetes Therapy)

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