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Review
. 2016 Sep;7(3):401-9.
doi: 10.1007/s13300-016-0187-6. Epub 2016 Jul 25.

Lipodystrophy in Insulin-Treated Subjects and Other Injection-Site Skin Reactions: Are We Sure Everything is Clear?

Sandro Gentile  1 , Felice Strollo  2 , Antonio Ceriello  3 ; AMD-OSDI Injection Technique Study Group
Collaborators, Affiliations
Review

Lipodystrophy in Insulin-Treated Subjects and Other Injection-Site Skin Reactions: Are We Sure Everything is Clear?

Sandro Gentile et al. Diabetes Ther. 2016 Sep.

Abstract

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 other skin lesions, such as bruising, as well as different needle injuries, including those associated with the subcutaneous injection of pegvisomant (a drug aimed at counteracting the high levels of growth hormone associated with acromegaly), long-acting exenatide (a glucagon-like peptide-1 receptor agonist), and anti-tumor necrosis factor-alpha biologic agents (used against Crohn's disease). In these latter cases specific studies are warranted to understand the pathophysiological background and possible prevention. However, the most common lesion is still insulin injection site-related LD, so a strong effort has to be made to avoid the confusion generated by previously misleading classifications which were barely able to reliably distinguish between LA and LH.

Keywords: Diabetes mellitus; Lipoatrophy; Lipodystrophy; Lipohypertrophy; Needle injury.

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Figures

Fig. 1
Fig. 1
Two examples of bruising due to insulin injection, in the absence of any antiplatelet and/or anticlotting agents
Fig. 2
Fig. 2
Lipoatrophy lesion on the left arm (left panel) and lipohypertrophy lesion on the right thigh (central panel). Right panel Result of repeated insulin shots within a restricted skin area
See this image and copyright information in PMC

References

    1. Blanco M, Hernández MT, Strauss KW, Amaya M. Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes. Diabetes Metab. 2013;39:445–453. doi: 10.1016/j.diabet.2013.05.006. - DOI - PubMed
    1. Holstein A, Stege H, Kovacs P. Lipoatrophy associated with the use of insulin analogues: a new case associated with the use of insulin glargine and review of the literature. Expert Opin Drug Saf. 2010;9:225–231. doi: 10.1517/14740330903496402. - DOI - PubMed
    1. Lopez X, Castells M, Ricker A, Velazquez EF, Mun E, Goldfine AB. Human insulin analog–induced lipoatrophy. Diabetes Care. 2008;31:442–444. doi: 10.2337/dc07-1739. - DOI - PubMed
    1. Phua EJ, Lopez X, Ramus J, Goldfine AB. Cromolyn sodium for insulin-induced lipoatrophy: old drug, new use. Diabetes Care. 2013;36:e204–e205. doi: 10.2337/dc13-1123. - DOI - PMC - PubMed
    1. Al Ajlouni M, Abujbara M, Batieha A, Ajlouni K. Prevalence of lipohypertrophy and associated risk factors in insulin-treated patients with type 2 diabetes mellitus. Int J Endocrinol Metab. 2015;13:e20776. doi: 10.5812/ijem.20776. - DOI - PMC - PubMed