Diabetes Care Community - Lipohypertrophy & Injection Techniques

FIT Technique Plus*
Lipohypertrophy
Supported by BD Medical – Diabetes Care
08-2013
What is lipohypertrophy?
Did you know?
Did you know?
Lipophyertrophy is present at the
injection sites of many people who
inject insulin.
• Lipohypertrophy, sometimes
referred to a “lipo”, is a thickened
rubbery area of fat tissue that can
grow and develop in the
subcutaneous fat where injections
of insulin are given.
• Areas of lipohypertrophy vary
greatly in size and are often felt
more easily than seen.4
• Regular site injection should be a
normal part of your injection routine.
To check your injection site, feel the
area where you normally inject. Look
for puffiness, raised areas and
redness. Feel for hardness or
lumpiness. If it is difficult to see your
injection sites, a mirror may help.
Lipohypertrophy can be prevented.
• The risk of developing
lipohypertrophy increases with
repeated injections into a small
area less than the size of a
postage stamp.3
Areas for injection should be at
least the size of a postcard and
each injection should be rotated
within the area, spaced at least
one finger width apart.5
In other
words, don’t inject in exactly the
same point each time.
Lipohypertrophy has also been
associated with needle reuse.
• Needles should be used only once
(and then disposed of in an
approved sharps container.)5
An area of lipohypertrophy can affect
your blood glucose control.
• Injecting into an area of
lipohypertrophy can cause irregular
insulin absorption and have an
impact on your blood glucose
readings.2
Talk to your doctor or diabetes
educator if you think you have
lipohypertrophy at your injection
sites.
1. Vardar B, Kizilc S. Incidence of lipohypertrophy in diabetic patients and a study of influencing factors. Diabetes Res Clin Pract 2007; 77:231-236.
2. Johansson UB, et al. Impaired absorption of insulin aspart from lipohypertrophic injection sites. Diabetes Care 2005;28(8):2025-7.
3. De Coninck C, et al. Results and analysis of the 2008-2009 Insulin Injection Technique Questionnaire Survey. J Diabetes 2010;2(3):168-79.
4. Frid A, et al. New injection recommendations for patients with diabetes. Diabetes & Metabolism 2010; 36: S3-S18.
5. Berard L, et al. FIT Forum for Injection Technique Canada. Recommendations for Best Practice in Injection Technique. October 2011.
*Educational tools based on
FIT Canada Recommendations for
Best Practice in Injection Technique.
www.fit4diabetes.com
• Your doctor or diabetes educator
can recommend a structured site
rotation plan that will work for
you. This will involve rotation
between injection sites and within
injection sites.
New needle
Reused needle
At x 370 magnification

FIT Technique Plus*
Needle Length
Supported by BD Medical - Diabetes Care
Did you know?
Did you know?
Did you know?
Insulin is best absorbed in the
subcutaneous layer
Insulin injected into the muscle will
not be absorbed properly. It may
be painful and could be the cause
of low or high blood sugars.
Needles come in many lengths
from 4mm to 12.7mm long.
How you inject your insulin matters
If you choose to use longer pen
needles or syringes, or if you are
extremely lean, you may need to
perform a skin lift in order to avoid
injecting into the muscle.
Review your injection technique with
your doctor or diabetes educator
today.
New research of the skin shows that
on average the skin is only 1.6-2.4mm
thick in all people living with diabetes.1, 5
This means that 4, 5
and 6mm needles are
suitable for all people
living with diabetes
who inject.4
*
* *
4 5 6
Skin
Subcutaneous
tissue
Muscle
HERE
NOT Here
NOT Here
4mm needle
1. Gibney MA, et al. Skin and subcutaneous adipose layer thickness in adults with diabetes at sites used for insulin injections: implications for needle length recommendations.
Curr Med Res Opin. 2010; 26 (6): 1519-1530.
2. Hirsch LJ, et al. Comparative glycemic control, safety and patient ratings for a new 4mm x 32G insulin pen needle in adults with diabetes. Curr Med Res Opin 2010;6:1531-41.
3. Hofman PL, et al. Defining the ideal injection techniques when using 5-mm needles in children and adults. Diab Care. 2010;33(9) 1940-1944.
5. Lo Presti D, et al. Skin and subcutaneous thickness at injecting sites in children with diabetes: ultrasound findings and recommendations for giving injection. Ped Diab 2012;13(7):525-53.
* The needles sizes are for illustrative purposes only and do not reflect the actual size.
12.7mm x 29g
8mm x 31g
6mm x 32g
5mm x 31g
4mm x 32g
Needles actual size
1

FIT Technique Plus*
Making Injections more Comfortable
Supported by BD Medical – Diabetes Care
05-2013
Did you know?
Top tips for comfort4
Did you know?
• Injectable therapy is an option
to treat diabetes and can help
you achieve better blood
glucose control.
• Over the years needle technology
has improved. Some pen needles
are shorter, finer and have
extra thin wall technology.
These improvements all make
injecting more comfortable than
you might think.
• Injection technique also matters.
When done properly, injections can
be virtually pain free.
• If you are new to injecting, ask
your educator to demonstrate
proper technique using a pen and
a shorter, finer pen needle.
• Shorter needles means a reduction
in anticipation of pain and in
actual injection pain.1
• Bleeding is more likely to be
associated with injection pain;
smaller diameter needles cause
less bleeding, therefore less pain.1
1 Keep injectable therapy in use at
room temperature.
2 Use a new needle each time.
3 Use shorter needles and smaller
diameter.
4 Inspect and palpate the skin prior
to each injection to ensure
injection site is healthy.
5 Inject solution slowly and evenly.
6 Avoid using alcohol to swab skin,
but if used, inject only after it has
dried completely.
7 Avoid injecting into hair roots,
scars and moles.
8 Avoid injecting though clothing.
9 If the volume of your injection is
uncomfortable, talk to your doctor
about how to divide into 2
injections.
1. Aronson R. The Role of Comfort and Discomfort in Insulin Therapy. Diabetes Technology & Therapeutics. April 2012;14(8):1-7.
2. Hirsch LJ, et al. Comparative glycemic control, safety and patient ratings for a new 4mm x 32G insulin pen needle in adults with
diabetes. Curr Med Res Opin 2010;6:1531-41. 3. Hirsch LJ, et al. Impact of a Modified Needle Tip Geometry on Penetration Force as well
as Acceptability, Preference, and Perceived Pain in Subjects with Diabetes. J Diabetes Sci Technol 2012;6(2):328-335.
Recommended reading
Injection technique resource:
http://www.bd.com/ca/diabetes/english
/page.aspx?cat=14501
4 5 6
Needles actual size
4mm x 32G 5mm x 31G 6mm x 32G tip

FIT Technique Plus*
Site Selection & Site Rotation
06 -2013
Did you know?
Did you know?
Did you know? My Site Rotation Plan
The preferred
areas to
inject are:
• abdomen
• thighs
• buttocks
The back of the
arm may also be
used but you
may need help in
order to reach
the correct area.
A structured rotation pattern
includes rotation between injection
sites and within an injection site.
For example,
1. Divide your abdomen injection
area into 4 areas.
2. Divide each area into smaller
sections. Use only one section
each week.
3. Rotate within that section, in a
circular pattern, with the next
injection being 2-3cm from
your last.
4. Rotate to the next section the
following week, etc.
Risk of lipohypertrophy, at your
injection sites is higher when you
don't change injection sites often.
Injecting into an area of
lipohypertrophy may keep your
insulin from working the way it
should. That’s why it’s important to
rotate properly and check your site
before you inject.
Steps for site inspection:
1. Stand up and feel the area
where you normally inject.
1 Vardar B, Kizilc S. Incidence of lipohypertrophy in diabetic patients and a study of influencing factors. Diabetes Res Clin Pract 2007; 77:231-236.
2 Johansson UB, et al. Impaired absorption of insulin aspart from lipohypertrophic injection sites. Diabetes Care 2005;28(8):2025-7.
3 Cureu B, et al. VDBD Guide: The injection in diabetes mellitus. (written in German), May 2011.
4 Bärtsch U, et al. Injectable therapy Pen Devices for treatment of diabetes (article in German). Ther Umsch 2006; 63: 398-404.
5 Patton SR, et al. Survey of Insulin Site Rotation in Youth With Type 1 Diabetes Mellitus. J Pediatr Health Care 2010; 24: 365-371.
6 Berard L, et al. FIT Forum for Injection Technique Canada. Recommendations for Best Practice in Injection Technique. October 2011.
rotate the site you use rotate within the site you use
It’s all about
keeping your
injection sites
healthy.
Establish a
routine and
keep track!
There are many examples of how to
rotate your injection sites. Your
diabetes educator can assess your
sites, or “real estate” to help you
design a site rotation plan that will
work best for you.
See next page for an example of an
injection site rotation plan.
abdomen thigh buttocks back of arms
1.
1.
2.
2.
3.
3.
4.
4.
2. Look for puffiness, raised areas,
redness, hardness or lumpiness.
3. Discuss any concerns with your
doctor or diabetes educator.

FIT Technique Plus*
Site Selection & Site Rotation
06 -2013
My Site Rotation Plan
Notes…

Diabetes Care Community - Lipohypertrophy & Injection Techniques

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