Take the Diabetes Health Pump Survey
See What's Inside
Read this FREE issue now
For healthcare professionals only
  • 12 Tips for Traveling With Diabetes
See the entire table of contents here!

You can view the current or previous issues of Diabetes Health online, in their entirety, anytime you want.
Click Here To View

See if you qualify for our free healthcare professional magazines. Click here to start your application for Pre-Diabetes Health, Diabetes Health Pharmacist and Diabetes Health Professional.

Learn More About the Professional Subscription

Free Diabetes Health e-Newsletter
Latest
Popular
Top Rated
Diabetes Health Reference Charts
Type 1 Issues Archives
Print | Email | Share | Comments (8)

Insulin Tumors


May 25, 2011

Diabetes an invisible illness

Swimsuit season lasts for at least five months in the South. The good news is that we live close to the beach, but the bad news is that after 25 years of living with diabetes (and three Caesareans), my body is starting to read like a map of my medical journey.

Diabetes used to be an invisible illness. For years, no one knew that there was anything different about me unless I revealed it. I could sneak off to the bathroom and give myself a shot without anyone knowing. I could wipe the small dot of blood onto a tissue and return to the room, and my skin was unmarked and free from scars.

I eventually gained enough confidence to come out of the diabetes closet and stop trying to hide my disease from the world. My journey toward acceptance began when I became a mother and discovered a surprising physical strength. This body that had been a source of shame, fear, and sadness transformed itself into something beautiful in pregnancy and motherhood.

I am now the mother of three boys who shop with me every spring when it's time for a new swimsuit. In years past, their small bodies crowded around me in the narrow, brightly lit dressing room, smiling and telling me I looked pretty in every single suit. They always made me feel beautiful even when my reflection didn't live up to the expectations in my head.

This year was different. "What are those bumps on your stomach?" Miles asked as I fastened the bikini top around my bra. My heart sank. I looked down at the two small lumps on either side of my belly button where I like to do my shots. "They're from Mommy's shots," I said. "Ouch," Miles said, and then, distracted, "Can we go look at the toys now?" I nodded, left the rest of the suits on their hangers, and ushered the boys out of the dressing room. I was not buying a new suit.

I have been injecting insulin into my stomach, arms, legs, and butt since I was fourteen years old. I've maintained good control ever since I became pregnant more than a decade ago, and I have always shrugged off talk of long-term complications. I told myself that because I was in good control, I was going to be just as healthy as anyone else, and free from any visible signs of illness. Until that day in the dressing room.

Lumps and bumps (lipohypertrophy) or depressions (lipoatrophy) below the surface of the skin are formed when a person injects insulin into the same spot over a number of years. Sometimes called "insulin tumors," these benign swellings of fatty tissue are one of the most common complications of insulin therapy. (Hambridge, 2007). Dr Liz Stephens says she sees this condition a lot, "probably more with injections than pumps, but definitely with both; especially in leaner people who don't have a lot of options for sites. I would say it affects, or has affected, over 50 percent of those I see with type 1 diabetes who have had it for more than ten years."

In his study in the British Journal of Nursing, titled "The management of lipohypertrophy in diabetes care," Kevin Hambridge states, "The prevalence of lipohypertrophy is estimated between 28.7% and 65% in patients with type 1 diabetes and between 3.6% and 35% in patients with type 2 diabetes." The reason for the differences between the groups is the frequency of injections.

Claire Blum, a CDE who has type 1 diabetes, says, "I have areas that are no longer useable for pump infusion due to scar tissue (I've worn a pump for nearly 25 years) and areas that pooch as well. I also have a place on my arm where the lipoatrophy never subsided from use of those old, dull needles that I re-sharpened and sterilized....The best option is to rotate religiously, avoiding use of areas within one inch to two inches of previous sites for 30 days or more. You may also want to avoid use of those specific areas entirely, as the appearance does gradually improve."

People with diabetes tend to inject and/or place their pumps into the same site because that area is easy to reach, less painful, and habitual. Legs have shown the highest frequency of lipohypertrophy, at 58 percent, followed by the abdomen at 48 percent, arms at 21 percent, and buttocks at 6 percent. (Hambridge, 2007).

Dull needles and higher frequency of injections are also risk factors for developing lipohypertrophy. Jenny, a member of TuDiabetes, says, "I've been diabetic since 1990, and there just aren't enough places to poke after all those years!"

Not only are lumps and bumps unattractive, but they can also result in poor insulin absorption. "The biggest danger is that absorption is so unpredictable, and blood sugars can do all sorts of things. And then when people move to new sites, their insulin requirement usually drops a lot, which can be risky for hypos," says Dr. Stephens.

Some studies show that patients have been treated successfully with cosmetic and therapeutic treatment by suction-assisted lipectomy. Dr. Stephens says, "In terms of prevention, there is not much to do except to avoid using affected sites, and rotate. I have had a couple of patients who have had plastic surgery, but usually they were people who have had diabetes for decades and had really severe issues and/or disfigurement."

Doctor Darrick Antell, official spokesperson for the American Society of Plastic Surgeons and Professor of Plastic Surgery affiliated with Roosevelt Hospital, says that plastic surgery is a safe option for people with diabetes. Liposuction is Dr. Antell's number-one surgery, and eight to 10 percent of his patients have diabetes . "Diabetes doesn't mean you can't have surgery," he says. "Liposuction can give you a boost in self-image, your clothing will fit better, and it will help with contour issues."

Another option for lipohypertrophy is site rotation. In their study, "Incidence of lipohypertrophy in diabetic patients and a study of influencing factors," Bahar Vardar and Sevgi Kizilci emphasize the importance of site rotation. "If a diabetic uses at least six injection sites (right and left arms, abdomen, legs) and uses each injection site for one week, it will be five weeks before he/she returns to the same site. During this time the tissue is free from the effect of insulin....The development of lipohypertrophy is in this way diminished because of the lessening effect of insulin in the area." The researchers also cited the importance of good self-management training from diabetes educators in order to increase the likelihood of patients sticking with this type of rotation.

Ever since I was 14 years old and my doctors told me the story of my own cells attacking each other, my body has remained a bit of a mystery. Now that I can see the results of this war, it's harder to pretend I'm just like everyone else. Does that mean I will wear my scars with pride? I don't think so, but I'm not sure I'll opt for surgery either. My lumps and bumps are right next to my Caesarean scar, and both are signs of the strength within.

Tips on reducing risks
• Injection sites should be palpated (physical examination) once a year instead of being visually examined.
• Be aware of the importance of site rotation.
• Use a fresh needle for each insulin injection.
• Use a wide site rotation for injection and pay attention to avoid injecting insulin close to sites with lipohypertrophy.
• Talk to your doctor about changing insulin. Newer insulin types (lispro, aspart) have reduced the prevalence of lipohypertrophy to some extent because they are more rapidly absorbed and the fat cells are less exposed to and affected by the insulin.


References:
1. Hambridge, K. (2007, British Journal of Nursing) The management of lipohypertrophy in diabetes care.
2. Vardar B. and Kizilci S. (2007, Diabetes Research and Clinical Practice) Incidence of lipohypertrophy in diabetic patients and a study of influencing factors.


Categories: Complications & Care, Depression, Diabetes, Diabetes, Insulin, Insulin Injection, Insulin Tumors, Pumps, Type 1 Issues, Type 2 Issues



You May Also Be Interested In...


Comments

Posted by Anonymous on 25 May 2011

This is the problem with sub-q insulin injections and its disconcerting that after 89 years, we still inject insulin. Then you have the JDRF and their "Artificial Pump" program which doctors will eventually start to pimp. Its bad enough inserting one catheter and now they want us to do two? Yeah right! I'm sick and tired of injections, and so is my body. After 30 years of this, I can literally grab a handful of scar tissue and no wonder why control is becoming ever increasingly difficult. There are only so many sites you can use after injecting yourself 1,460 times per year. There has to be a better delivery system.

Posted by Anonymous on 25 May 2011

The insulin pump is not much better of an alternative to needles. It's less often but also a bigger hole, less available sites to do it in.

Posted by MyAdvocates on 26 May 2011

The FDA needs to strengthen drug testing requirements for pharmaceutical companies to prevent the kind of sleight-of-hand used by GlaxoSmithKline to win approval for Avandia, the popular drug prescribed to millions that has been associated with increased heart attacks, strokes and heart-related deaths -- evidence buried by GSK.

Posted by goozer on 26 May 2011

I have had type 1 for 63 years. I only started to use a pump 10 years ago. For some reason I don't have the lumps. I use each thigh for 10 insertions which gives me 60 days before returning to one. I can't figure out how to use my arm for a pump site and don't like to use my belly. My jeans are too snug!! My butt is too hard to visualize though I have used it at times. Do I ever remember those needles the size of hoses! And the glass syringes and the clinitest urine tests. Thank God things are better today. I can't imagine what life will be like in another 63 years.

Posted by Anonymous on 26 May 2011

I find this authors use of the term "insulin tumors" to be an unfortunate one. When I read it, my first thought was cancer, or the usually benign beta-cell tumor, known as an insulinoma.
I would suggest to Ms Mercer not to throw around terms like "tumor" carelessly. A real tumor would definitely spoil your day on the beach...

Posted by Anonymous on 27 May 2011

It's so encouraging to read posts from people who have had diabetes for 30 years or more. I've had type 1 for 30 years and I'm grateful I don't have any major complications (yet). Goozer is incredible---63 years! How old are you now? Yes, I, too remember those glass syringes that I had to immerse in boiling water to sterilize, and those needles that I had to inject in a slanted position because they were too long for subcutaneous use. Something that was not mentioned in the article and in the posts is that the injection site also affects the length of time it takes for the insulin to start working. I find that the abdomen is the fastest and the thigh is the slowest. I tend to favor the abdomen myself so I don't have to wait for a long time before my meal. As for swimsuits---I gave them up some 15 years ago. I wear only loose-fitting clothes now to hide my bulging tummy.

Posted by amysmercer on 28 May 2011

I want to respond to "anonymous" who used the word "careless" to describe the title of this article. I refer to "Insulin Tumors" in the article to describe the lumps an bumps because that is the medical term that is sometimes used to describe this condition. I think the language of illness is a powerful tool and there are a lot of words I wish weren't in my dictionary (chronic, seizure, complications etc.), but sometimes the words to describe illness are as ugly as the truth. Whether it is described as a tumor or a lump, it's still scar tissue from years of injections. Nothing I write is careless.

Posted by Anonymous on 7 July 2011

For all those of whom took this article so seriously... this is an article about swimsuit shopping. And as a woman, a mother and a Type 1 of 36 years, with scar tissue galore, I appreciate that someone took the time to write a post that reminded me I am not alone!


Add your comments about this article below. You can add comments as a registered user or anonymously. If you choose to post anonymously your comments will be sent to our moderator for approval before they appear on this page. If you choose to post as a registered user your comments will appear instantly.

When voicing your views via the comment feature, please respect the Diabetes Health community by refraining from comments that could be considered offensive to other people. Diabetes Health reserves the right to remove comments when necessary to maintain the cordial voice of the diabetes community.

For your privacy and protection, we ask that you do not include personal details such as address or telephone number in any comments posted.

Don't have your Diabetes Health Username? Register now and add your comments to all our content.

Have Your Say...


Username: Password:
Comment:
©1991-2014 Diabetes Health | Home | Privacy | Press | Advertising | Help | Contact Us | Donate | Sitemap

Diabetes Health Medical Disclaimer

The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained on or available through this website is for general information purposes only. Opinions expressed here are the opinions of writers, contributors, and commentators, and are not necessarily those of Diabetes Health. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website.