Subcutaneous injection of insulin can result in changes in the subcutaneous fat. The reactions can be reduced but not eliminated by using purified preparations and good injection technique.
Lipoatrophy consists of atrophy of adipose cells in the subcutaneous tissue, which may occur at the site of insulin injection or at sites never injected, such as the face, neck and chest. The cause is unknown but could be due to poor injection technique or cell-mediated immunity.
Lipohypertrophy consists of a proliferation of adipose and fibrous tissue, possibly in response to anabolic and lipogenic effects of the insulin. It usually results from repetitive injections at the same site.
Finding
Lipoatrophy
Lipohypertrophy
clinical appearance
circumscribed area of depressed skin
firm, nontender lesion resembling a lipoma
gender predilection
female
male
effect
cosmetic if visible
slower insulin absorption
management
may resolve with injection of insulin at the periphery
rotate injection site; excise lesions if severe
Differential diagnosis:
(1) abscess
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