One injection site is shown in Panel B (arrow). Injection-site lipoatrophy is a recognized complication that is associated with all types of insulin and that has an estimated. . . Adziri Harold.. Lipoatrophy at insulin injection site. Velayutham P(1), Shriraam M, Bhadada S, Bhansali A. Author information: (1)Department of Endocrinology, PGIMER, Chandigarh 160012 He developed subcutaneous fat atrophy around the injection site 16 months after induction of insulin therapy. Skin biopsy of the atrophic site revealed inflammatory changes and adipocyte atrophy. Changing the type of insulin and injection site relieved the fat atrophy Physicians and patients have long been aware of skin lesions at the sites of insulin injections, referred to as lipodystrophy that can present as lipoatrophy (LA) or lipohypertrophy (LH). However, the reported prevalence of these different skin lesions varies widely, emphasizing the need for a correct identification method
. However, lipoatrophy developed at the new injection sites in patient 2 and 4 and resolved after changing the insulin preparation (NovoMix 30 to Humalog Mix25 and Levemir to insulin Glargine) Lipoatrophy is the breakdown of adipose tissue at the insulin injection site causing a depression in the skin at the injection site and occasionally at distant sites also. It may be the result of an immune response or the use of less than pure insulin
What most people think is scar tissue is actually insulin lipohypertrophy — localized hypertrophy of subcutaneous fat at insulin injection sites, caused by the lipogenic effect of insulin. If you.. Insulin Hypertrophy Insulin hypertrophy (also known as lipohypertrophy) results in adipose tissue enlargement near the site of insulin injection. This can result in fatty, lumpy areas. The cause is not known but is thought to be a consequence of insulin increasing glucose absorption and fat production injection sites of our insulin treated patients for evidence of lipohypertrophy and lipoatrophy to establish the present frequency of these potentially avoidable complications. Methods The injection sites of281 (151 M:130F) consecutive insulin treated diabetics attending a diabetic clinic over a 3 month period were examined (by PGM and NIJ) for. Lipodystrophy: a side-effect of not rotating injection sites Lipodystrophy (LD) is a condition affecting body fat tissue and it's very common in people who take multiple daily insulin injections. Other variations include lipohypertrophy (LH) or lipoatrophy (LA) Lipohypertrophy is thought to be the direct anabolic effect of insulin on local skin leading to fat and protein synthesis 9 and hence this is observed even with recombinant insulin preparations and continuous insulin infusion pumps. This complication occurs because of repeated injections at the same site
Lipoatrophy or local fat loss is one of the skin complications of insulin injection and is clinically characterized by visible cutaneous depression and palpable atrophy of subcutaneous fat tissue at the injection site Circumscript, progressing lipoatrophy at the insulin injection sites is an unexplained, however rare condition in diabetes mellitus. We report a case of severe localised lipoatrophy developing during insulin pump-treatment (continuous subcutaneous insulin infusion) with the insulin analogue lispro (Humalog®) in a woman with type-1 diabetes mellitus Skin biopsy of the atrophic site revealed inflammatory changes and adipocyte atrophy. Changing the type of insulin and injection site relieved the fat atrophy. Although insulin-induced lipoatrophy was a common complication before the development of human insulin, it is now rare Lipoatrophy is the breakdown of adipose tissue at the insulin injection site causing a depression in the skin at the injection site and occasionally at distant sites also. From: Advances in Drug Research, 199 2.2 Lipoatrophy. Lipoatrophy (), now largely of historic interest, is considered to be a local allergic reaction at the site of insulin injection caused by impurities present in older insulin preparations.Many patients with lipoatrophy also suffered from other allergic reactions to insulin. As recently reviewed, insulin injected into the subcutaneous tissue can elicit various reactions from.
Physicians and patients have long been aware of skin lesions at the sites of insulin injections, referred to as lipodystrophy that can present as lipoatrophy (LA) or lipohypertrophy (LH). However, the reported prevalence of these different skin lesions varies widely, emphasizing the need for a correct identification method. In this short review we discuss LA and LH and also take into account. Lipoatrophy. Rotating injection sites prevents skin problems from injecting insulin. A depression in the skin's fatty underlayer caused by insulin injections which can be eliminated by either rotating the injection site or altering one's injection technique. A kind of lipodystrophy, opposite to lipohypertrophy
Lipohypertrophy is a potential clinical adverse effect associated with intensive insulin therapy. Insulin-induced lipohypertrophy is the loss of subcutaneous fat at the site of insulin injection. Lipohypertrophy seems to be due to a cellular response of adipocytes to the local effects of injected insulin Examination revealed lipoatrophy involving the abdominal wall, lateral thighs, and buttocks, all of which were sites of previous insulin infusions. These cases highlight a potential for lispro insulin to induce lipoatrophy. While CSII may have contributed to the problem, use of lispro appears to be the most important factor Interestingly, insulin-induced lipoatrophy also improved not only at the insulin injection site but also at the distant site. It has been reported that one of the adipose tissue-specific effects of thiazolidinediones is the stimulation of adipocyte differentiation ; thus, pioglitazone might reverse the dedifferentiated adipocytes of the.
There are 2 common problems that can occur at insulin injection sites: Lipoatrophy Lipohypertrophy Lipoatrophy Lipoatrophy means fat under the skin disappears and it causes shallow indentations in the skin at the injection site. This happens because of allergic reaction in which the fatty tissue is destroyed. Lipohypertrophy Lipohypertrophy means excessive growth of fat cells [ Mast cell stabilizing therapy with topical cromolyn can reverse early injection-site lipoatrophy induced by human insulin analogs, and prevent further lesions. Dr. Allison B. Goldfine from the Joslin Diabetes Center, Boston, Massachusetts states that, The problem of local lipoatrophy is uncommon, and the kinetic advantages of insulin. Lipoatrophy (LA), defined as a loss of sc fat around the site of repeated insulin injections, is a rare complication of insulin therapy causing erratic insulin absorption ().In the past, 25-55% of insulin-treated patients displayed LA, probably due to a local allergic reaction to impurities present in insulin preparations ().With the development of highly purified insulin, recombinant human. Multifocal lipoatrophy secondary to insulin injection in a patient with type 2 diabetes, hepatitis B virus infection, and liver cirrhosis Yuedan Wu and Xiaojia Lou Abstract Lipoatrophy secondary to insulin injection is a rare complication of insulin use. Localized lipoa-trophy is recognized by a loss of subcutaneous fat caused by insulin injection
Introduction. Lipoatrophy is a recognised complication of insulin therapy characterised by a disfiguring loss of subcutaneous fat at the site of insulin injections. 1 Prior to the introduction of human insulin, lipoatrophy was relatively common with a recorded incidence varying between 10% 2 and 54%. 3 However, since the introduction of insulin analogues, lipoatrophy has become comparatively rare Original Article from The New England Journal of Medicine — Lipoatrophy Following the Injection of Insulin — A Method of Control with the development of local fat atrophy at the site of. Localized acanthosis nigricans at the insulin injection site is a rare skin disorder in patients with diabetes mellitus. We report co-existence of acanthosis nigricans and lipoatrophy at injection sites in the same patient with type 1 DM. A 23 year old male patient with a history type 1 DM for 11 years was admitted to hospital due to recurrent. Lipoatrophy was not influenced by type of insulin therapy (p=0.44) but was found to be associated with less frequent injection site alternation in patients using multiple daily injections (p=0.01). Also, HbA1c level was positively associated with lipoatrophy ( p =0.01) Topical dexamethasone injections have been tried for the management of insulin induced lipoatrophy. It is important that these complications are recognised and managed appropriately. Insulin absorption from these sites is unpredictable and can lead to erratic glycaemic levels and unpredictable hypoglycaemic attacks. This article raises.
Management for lipoatrophy caused by insulin injections require the shift from animal insulin to purified human insulin. Prevention of Lipoatrophy. Localized lipoatrophy is primarily prevented by rotation of injection sites. Everyday injections should be administered in different parts of the body to minimize overuse of a certain spot which may. The preferred site for insulin injection is your abdomen. Insulin is absorbed more quickly and predictably there, and this part of your body is also easy to reach. Select a site between the bottom. ABSTRACT Objective: To evaluate the management of insulin-induced lipoatrophic areas with local subcutaneous glucocorticoid injection. Methods: A 42-year-old woman with type 2 diabetes mellitus, who was taking biphasic insulin aspart for the last 3 years, presented with two areas of lipoatrophy of insulin injection sites on the anterior abdominal wall Frequency not reported: Lipodystrophy including lipohypertrophy and lipoatrophy . Long-term use of insulin may cause lipodystrophy at the site of repeated injection. Lipodystrophy includes lipohypertrophy, a thickening of adipose tissue, and lipoatrophy, thinning of adipose tissue. Gastrointestina subcutaneous insulin infusion (CSII) pump for the management of type 1 diabetes. We did not observe any cases of lipoatrophy in patients receiving multiple daily insulin injections. In examining the effect of lipoatrophy on glycaemic control, we found no detrimental effect of lipoatrophy on the patients' glycated haemoglobin
Insulin injections - diabetics may experience localised lipoatrophy at repeated injection sites; Other injections - lipoatrophy has been reported to follow injections with penicillin, iron, growth hormone, vaccines, illicit drugs, and acupuncture ; Panniculitis. Panniculitis is the term used for inflammation of subcutaneous fat Injection site rotation is the systematic switching of insulin injections from one site to another. For years, doctors have emphasized the need for people with diabetes to rotate their injection sites rather than injecting into the same place each time. Injecting into the same spot can cause lipohypertrophy, the buildup of fat under the skin. Lipodystrophy or lipoatrophy is a recognized complication of Insulin injection due to loss of the adipose tissue layer at the sites of injection (prevalence of 3.6%). Axial magnetic resonance imaging of the right thigh showed Lipoatrophy of a 14-year-old girl with a 20-month history of type 1 diabetes mellitu Lipohypertrophy is a medical term that refers to a lump under the skin caused by accumulation of extra fat at the site of many subcutaneous injections of insulin. It may be unsightly, mildly painful, and may change the timing or completeness of insulin action. It is a common, minor, chronic complication of diabetes mellitus
To prevent lipoatrophy and lipohypertrophy in patients receiving insulin injections, a nurse should. asked Nov 1, 2016 in Nursing by silence. 1. Massage the injection site. 2. Occasionally administer injections in the ventrogluteal site. 3. Rotate injection sites around the abdomen. 4. Always inject in the same site lipoatrophy (lip-oh-at-rŏ-fi) n. an immune reaction to insulin injections close to the site of injection, resulting in localized hollowing of the fat tissue. It is rarely seen with more modern, highly purified, insulins. Source for information on lipoatrophy: A Dictionary of Nursing dictionary Common (1% to 10%): Injection site reactions (including rash, redness, inflammation, pain, itching, and bruising) Frequency not reported: Lipodystrophy (including lipohypertrophy, lipoatrophy) Postmarketing reports: Localized cutaneous amyloidosis at injection site. Cardiovascular. Insulin may cause sodium retention and edema, especially as. Insulin-induced lipoatrophy appears to be associated with local hyperproduction of tumor necrosis factor-α and interleukin-6, which would lead to a dedifferentiation of adipocytes. 5 The injection itself could also play an important role in the development of lipoatrophy by causing macrophages to release cytokines, which in turn enhance the.
She suffered some lipoatrophy as an adolescent, Erratic control should prompt an inspection of injection sites, and allergy to insulin preparations should be considered. For patients with such a long history of diabetes we may assume that they are aware of the importance of injection site rotation and potential side effects of treatment. When you receive recurrent injections on one spot of your body, the macrophages release cytokines, which lead to breakdown of your adipose tissue causing lipoatrophy. There are many medicines that are injected through the subcutaneous layer such as heparin, insulin injection and human growth hormone injections insulin lipoatrophy lipoatrophy in the subcutaneous tissues because of repeated injection of insulin at the same site Most cases are considered idiopathic. In cases linked to insulin injections, an immune response mediated by tumor necrosis factor-α has been hypothesized . The development of localized lipoatrophy associated with corticosteroid injections is a well-described phenomenon. It has been reported with the use of triamcinolone
Know about rotating injection sites. Injection site rotation is no longer necessary as newer insulins have a lower risk for hypertrophy of the skin. Typically, a patient will pick one anatomic area (e.g., upper arm) and rotate the injection sites within that region to maintain consistent insulin absorption from day to day Lispro insulin-induced lipoatrophy: a new case. Pediatric Diabetes, 2007. Sultan al-Khenaiza Injecting any insulin at the same site repeatedly over time or blunting a needle with re-use can cause a lipodystrophy: either lipoatrophy or lipohypertrophy. Either makes absorption unreliable. But varying the injection site can cause variability in action profile, too Injection-site lipoatrophy. N Engl J Med. 361 (19):e41, 2009. Kim J et al: Heterotopic ossification developing in surgical incisions of the abdomen: analysis of its incidence and possible factors associated with its development. J Comput Assist Tomogr. 32 (6):872-6, 2008 Aim. To investigate whether zinc‐free insulin is an effective treatment option for lipoatrophy. Methods. Controlled, randomized, open‐label parallel study in young people with type 1 diabetes, pump treatment and lipoatrophy at injection sites
Lipodystrophy or lipoatrophy is primary idiopathic atrophy of adipose tissue. Lipodystrophy is a very rare disorder with no known etiology. Lipodystrophy can be total, partial, or localized.  Total lipodystrophy consists of congenital or acquired complete loss of adipose tissue usually associated with hepatomegaly, hyperglycemia, insulin resistance, hyperlipidemia, and hypermetabolism Other injection site adverse events observed during DURATION-1 were generally mild in intensity and relatively rare, and mostly disappeared within a month. The most common among them was pruritus at the injection site, although its rate appeared to wane over time from 11.0% between weeks 4 and 6 to 4.6% between weeks 28 and 30 (Grimm 2013) lipoatrophy: [ lip″o-at´ro-fe ] 1. atrophy of subcutaneous fat. 2. lipodystrophy . insulin lipoatrophy lipoatrophy in the subcutaneous tissues because of repeated injection of insulin at the same site Lipoatrophy at injection sites is a common complication of treatment with insulin and has been reported in 10%,' 24o%,2 and55%3 of patients treated withconventionalbovineinsulins Lipoatrophy is rarely seen in practice with analogue insulin and to our knowledge this side effect was not reported so far with biphasic aspart. The management of this condition remained unsatisfactory but ranges from changing injecting sites, changing insulin type (perhaps now to Exubera), to local injections of steroids (2,3)
Insulin-induced lipoatrophy, a rare, albeit feared condition, 1 can be defined as an immune-mediated loss of subcutaneous adipose tissue at insulin administration sites. 2 Lipoatrophy. and lipohypertrophy. Th e development of lipoatrophy may have an immunological basis, predisposed by lipolytic com-ponents of certain insulins. Lipohypertrophy is the most common cutaneous complication of insulin therapy1. GENERAL CONSIDERATIONS Lipoatrophy is defi ned by the loss of subcutaneous fat at the site of insulin injection Lipohypertrophy. Learn about lipohypertrophy and what you can do to avoid it. Lipohypertrophy, or just lipo, is a common complication, affecting anywhere from about half to three-quarters of people who inject insulin. In addition to being unsightly, lipo can affect your diabetes management if you are not careful about keeping your injection sites healthy. Changing the type of insulin and injection site relieved the fat atrophy. Although insulin-induced lipoatrophy was a common complication before the development of human insulin, it is now rare. The immunological reaction to the insulin product, as in conventional impure insulin-induced lipoatrophy, seemed to be involved in the etiology of.
Lipoatrophy at injection sites has been associated with all types of insulin, it has an estimated prevalence of 3.6%. The precise pathogenesis remains unclear, but possible mechanisms include immune reaction to insulin or excipients of the injection solution, injury from cold insulin, or trauma from repeated local injections Injection site lipoatrophy can be associated with insulin, corticosteroids, and antibiotics, among others, and history is a key component of making this diagnosis. Lipoatrophy associated with HIV is thought to result from antiretroviral treatment, although the exact mechanism is unknown. Codes ICD10CM
Acquired lipodystrophy may also appear at steroid injection sites, repeated insulin injection sites or in other injection sites like penicillin, acupuncture, iron, growth hormone and vaccines. Inflammation of subcutaneous fat (panniculitis) and progressive hemifacial atrophy are also called acquired lipodystrophy. Lipoatrophy can be treated. The BD Diabetes Learning Center describes the causes of diabetes, its symptoms, and diabetes complications such as retinopathy and neuropathy. This site contains detailed information about blood glucose monitoring, insulin injection and safe sharps disposal insulin injection know-how learning how to inject insulin DELIVERING AN INJECTION: Select a site: Choose a spot on your skin that you can see and reach. It is important to not overuse any particular area of skin. See the information below on rotating injection sites. Make sure skin is clean: It is generally not necessary to wip Localized acanthosis nigricans at the insulin injection site is a rare skin disorder in patients with diabetes mellitus. We report co-existence of acanthosis nigricans and lipoatrophy at injection sites in the same patient with type 1 DM. A 23 year old male patient with a histor
The final site for administering an insulin injection is the lower back or hip. To administer an injection here, draw an imaginary line across the top of the buttocks between the hips Skin biopsy samples from 14 diabetic patients with lipoatrophy at injection sites and from five insulin-treated diabetic patients without such lipoatrophy (controls) were examined by immunofluorescence for the deposition of immunological components. Also sera from 13 of the patients with lipoatrophy and from all of the controls were assayed for insulin-binding capacity • Injection site lipoatrophy Loss of fat at sites of repeated insulin injections May be caused by allergic response to insulin, but now less common with use of human insulin • Injection site lipohypertrophy Proliferation of fat and fibrous tissue at site of repeated injections FIGURE 1 .1Severe lipoatrophy lesions in (A), (B) and (C). Improvement of lipoatrophy before (C) and after (D) 4 weeks of therapy with topical cromolyn. Acute injection site with marked lobular lymphocytic infiltrate (E) and numerous eosinophils (F) under H & E staining
Insulin-induced lipoatrophy is a rare skin complication in patients with diabetes mellitus. It is characterized primarily by localized subcutaneous atrophy of the fatty tissue at the site of frequent insulin injection. We report a clinical case of a 38-year-old woman with lipoatrophy, developed during treatment with insulin analogues Circumscript, progressing lipoatrophy at the insulin injection sites is an unexplained, however rare condition in diabetes mellitus.We report a case of severe localised lipoatrophy developing during insulin pump-treatment (continuous subcutaneous insulin infusion) with the insulin analogue lispro (Humalog®) in a woman with type-1 diabetes mellitus
Chakraborty PP, Bhattacharjee R: Injection site lipoatrophy: a rare complication of recombinant human insulin. J Assoc Physicians India. 2010, 58: 630-PubMed Google Scholar 21. Del Olmo MI, Campos V, Abellán P, Merino-Torres JF, Piñón F: A case of lipoatrophy with insulin detemir. Diabetes Res Clin Pract. 2008, 80: e20-e21 Lipoatrophy can also occur with continuous subcutaneous in-sulin infusion (CSII, insulin pump) (8), rapidly absorbed insulins, and more than one type of insulin analog in the same patient (9). Repeated use of the same insulin injection site and multiple usage of same pen needle increases the risk of lipoatrophy (3) rotation of injection sites would be a prudent option to decrease the chances of these complications. Both of the patients described here had lipoatrophy and lipohypertro-phy in different injection sites. After ensuring proper injection technique, including rotation of sites, both had improvement in A1C and glycemic variability Case reports: Four children with type 1 diabetes were commenced on Novomix 30 (n=2) or Novorapid/Levemir injections (n=2). They developed LA at the injection sites after 2-3 years. One patient developed LA at the Novorapid site and the other at the Levemir site. The mean HbA1C ranged from 8.0-9.9%. Insulin antibody levels were high in 3/4 injection into the same sites, inadequate site rotation and the reuse of needles, and incidence is increased with duration of diabetes, duration of insulin use and number of injections per day.1-4 LH is common, with studies finding that between 29 and 64% of insulin users are affected.1, 3-5 Lifted skin fold. A lifted skin fold is made usin
Insulin lipohypertrophy shows a tumor-like swelling of fatty tissue at the injection site due to the lipogenic effect of insulin (Fig. 7). Growth hormone receptor antagonist is also reported to be a cause of lipohypertrophy at the injection site . Lipoatrophy, which is considered to be an immune complex-mediated inflammatory lesion, rarely. Amelioration of Insulin Lipoatrophy by Dexamethasone Injection Thomas H. Whitley, MD; Patricia A. Lawrence, RN, MA; Carol L. Smith, RN \s=b\Widespread subcutaneous lipoatrophyoccurred in a 47-year-oldwoman aftersubcutaneous injectionsofisophaneinsulin suspensionforfivemonths. Subsequent systemi Lipoatrophy is an uncommon condition in which fat layers just underneath the skin start to disappear. The problem can occur in an isolated body part, such as the face or an arm, or cause widespread fat tissue loss. Many different factors can be involved in localized lipoatrophy, including corticosteroid shots, insulin injections for diabetes. The 4mm insulin pen needle has recently been shown to be safe and effective in all types of people, even obese ones (11-15). Use of such needles is an important advance not only in preventing IM deposition of insulin but in expanding injection sites so that better rotation habits are possible. These principals apply equally to infusion patients November 2005, Vol. 10, No. 3 Lipohypertrophy and lipoatrophy of injection sites was a major problem with the old impure insulins.1 The problem improved somewhat with the advent of the monocomponent bovine and porcine insulins and the current pure human insulins, such that lipoatrophy in particular is now very rare.1,2 However it now manifest These findings suggest that insulin-induced lipoatrophy results from the local formation of immune complexes, complement fixation, and release of inflammatory mediators from the cellular infiltrate. Introduction Lipoatrophy at injection sites is a common complication of treatment with insulin and has been reported in 10%,x 24 %,