Lipohypertrophy is a lump under the

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different de ...

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 Action may refer to: * Action (narrative), a literary mode * Action fiction, a type of genre fiction * Action game, a genre of video game Film * Action film, a genre of film * ''Action'' (1921 film), a film by John Ford * ''Action'' (1980 fil ...

. It is a common, minor, chronic complication of diabetes mellitus. Typical injection site hypertrophy is several inches or cm across, smoothly rounded, and somewhat firmer than ordinary subcutaneous fat. There may be some

scar A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a n ...

tissue as well, but the major component is

adipose tissue Adipose tissue, body fat, or simply fat is a loose connective tissue composed mostly of adipocytes. In addition to adipocytes, adipose tissue contains the stromal vascular fraction (SVF) of cells including preadipocytes, fibroblasts, vascular ...

, as insulin exerts a

hypertrophic Hypertrophy is the increase in the volume of an organ or tissue due to the enlargement of its component cells. It is distinguished from hyperplasia, in which the cells remain approximately the same size but increase in number.Updated by Linda J. ...

effect on adipose cells. To avoid lipohypertrophy, persons with

diabetes mellitus Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

who inject insulin daily for an extended period of time are advised to ''rotate'' their injections among several areas (usually upper, outer arms, outer thighs, abdomen below and around the umbilicus, and the upper parts of the buttocks). Rotation charts are often provided as part of diabetes education to help prevent lipohypertrophy. Lipohypertrophy usually will gradually disappear over months if injections in the area are avoided. It is a common misconception that the lump is largely scar tissue, as injection site hypertrophy is much rarer and milder with injections of other hormones and medications which lack the specific ability of insulin to stimulate adipose hypertrophy. In a sense, the "opposite" of injection site lipohypertrophy is injection site

lipoatrophy Lipoatrophy is the term describing the localized loss of fat tissue. This may occur as a result of subcutaneous injections of insulin in the treatment of diabetes, from the use of human growth hormone or from subcutaneous injections of copaxone us ...

, in which the subcutaneous fat around an injected area "melts away" over a few weeks or months, leaving unsightly, well-demarcated depressions in the skin. The mechanism of this local lipoatrophy is not understood and may involve autoimmunity or local inflammation.

See also

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Further reading