Featuring Robert Roscoe, BSc. Pharm, ACRP, CDE, CPT, Pharmacist and Certified Diabetes Educator

Duration: 3 minutes, 29 seconds

Insulin is best absorbed when it’s injected into healthy tissue. When you inject in the same spot over time, you develop something called lipohypertrophy, or lipos, or scar tissue, which is a thick, rubbery tissue develops in a subcutaneous area where you do your injections.

Also, when you don’t rotate your injection sites well, they can also develop with these types of circumstances. When insulin is injected into a lipo, it’s not absorbed as well as it is into healthy tissue. And because it’s not absorbed as well, it doesn’t have the same action as you would expect.

So, people that inject into lipohypertrophies can actually expect to have more wider ranges of highs and low numbers, but more importantly, can have unexpected low blood sugar numbers. Rotating your insulin injections is something important, and everybody should develop a plan that they can follow. You can simply do it by one of two methods. One is to change your site, so you can go from maybe the belly or abdomen to using your leg, to using your upper buttocks.

Another method is to use a certain area of the body, so if you choose to use the abdomen, you have to remember to rotate within that area as well. And rotating in that area is just as simple as moving your finger one width apart, or two centimetres, away from the previous injection.

By doing this we’re going to hopefully reduce the incidence of having lipohypertrophy. The important thing is that you really have to develop a method that you can follow yourself. One suggested method that is used commonly is to look at your belly and divide it into four parts. You would use one of those parts per week, but in that area where you’re injecting that’s where it’s important again to rotate. Make sure that you’re moving one injection to the next injection by that one-finger length apart.

This means is not the only method we could use to rotate our insulin sites, but it’s one that’s usually suggested, but talk to your healthcare team, as they may be able to have other suggestions you might be able to find easier to follow.

Proper site rotation and injection technique should require you to look at the sites you’re going to use for injection, which means you should look at those sites before doing your injection. What we’re really looking for is any unusual bumps and lumps, maybe red areas, puffiness, things along that area. But you should check with your diabetes team as well, as they should be checking these things as well.

One thing we want to tell you though is that you can do these on your own. There’s a couple of methods you could do to do this. One is just simply standing in front of a mirror and looking to see if there’s any different sites that may look a little different. But think of where you’re doing your injections.

Secondly, is that sometimes they’re better felt than seen, so sometimes it’s better to actually have a rub in those areas to see if something feels a little bit different. But the whole idea is to come up with a plan and do check them out on a regular basis, and to remind your healthcare team also to help you identify and check these as well.

Avoiding lipohypertrophies is a key component to insulin injection. So proper technique is key. Number one, by making sure you have a good rotation practice and avoiding repeated injections at the same site is important. Secondly is a re-use of needle tips. They’re designed to be used only once, and using them repeatedly gives a risk factor in developing lipohypertrophies.

For more information, I would make sure you contact your endocrinologist or specialist and family doctor, but sometimes more importantly your diabetes healthcare team. These include diabetes nurse educators, certified diabetes educators, pharmacists, dietitians and diabetes nurse educators.

Presenter: Mr. Robert Roscoe, Pharmacist, Rothesay, NB

Local Practitioners: Pharmacist