Lipohypertrophy at Injection Sites: An Underexamined Cause of Unexplained Glycaemic Variability
DOI:
https://doi.org/10.5281/zenodo.22261640Keywords:
Lipohypertrophy, Injection technique, Glycaemic variability, Hypoglycaemia, Site rotationAbstract
Insulin injected into lipohypertrophic tissue is absorbed erratically, and the consequence presents as unexplained glycaemic
variability and hypoglycaemia rather than as a skin complaint. Meta-analysis reports pooled odds ratios of 6.98 for unexplained
hypoglycaemia, 6.65 for hypoglycaemia overall and 5.24 for glycaemic variability where lipohypertrophy is present, with HbA1c
higher by 0.55 percentage points and daily insulin consumption by 7.68 units. Prevalence in an outpatient cohort of 430 was 64.4
per cent, and site rotation was the discriminating factor: only 5 per cent of those rotating correctly were affected, while 98 per
cent of those affected did not rotate or rotated incorrectly. Detection depends on method, with ultrasound identifying lesions in
over 80 per cent of cases and palpation missing non-palpable disease. The examination is recommended six-monthly for the first
two years of insulin therapy and is not routinely performed.
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