Glycemic control in patients with diabetes mellitus can be affected by multiple factors, including insulin injection technique. Lipohypertrophy-an often overlooked complication of repeated insulin injections-can lead to erratic insulin absorption and unexplained hyperglycemia. This case highlights the clinical importance of examining injection sites in patients with uncontrolled diabetes.
31 years old male , visited my OPD with complaints of uncontrolled sugars and epigastric discomfort. He is a Type 1 Diabetic since 16 yrs. He is on basal- bolus regimen using Human Actrapid and Inj Lantus (Glargine) .
He kept monitoring his sugars but was not under control over the past 3 months. He attributed this to probably the Glargine pen delivery device was malfunctioning.
He was consulting a Diabetologist elsewhere but had not visited his doctor for over a year.
Pt was admitted to monitor as sugars were persistently high. On admission, his random sugar was 599 mg %.
General Examination:
On physical examination, he was found to have 2 painless lumps over his abdominal wall and his thighs.
On enquiring; Pt admitted to having these for quite some time. He also admitted that he used to take his insulin repeatedly on the same site. Later after developing these lumps; he continued taking insulin there itself as the prick was painless.
Investigations:
RBS- 599 mg %
HBA1C-12.3 %
Urine for MICROALBUMIN-2787
There were no signs of infection or other causes of poor control.
Management:
Pt was admitted for monitoring and better glycemic control. Diabetic keto acidosis was ruled out. Initially he was started on Insulin infusion-short acting. After sugars were better, he was shifted to basal bolus regimen.
His sugars are better now and Pt is ready for discharge.
He was counselled on
• Proper insulin injection technique, including site rotation.
• Avoiding needle reuse.
• Avoiding injecting into areas of the lumps.
Discussion
Lipohypertrophy results from repeated trauma and local anabolic effects of insulin. It can significantly impair insulin absorption, leading to erratic or suboptimal glycemic control. Clinical examination remains a simple but often neglected tool in diabetes care. Educating patients on proper injection techniques is essential to prevent this complication.
Conclusion
This case emphasizes the need for routine examination of insulin injection sites and regular patient education on injection practices. Recognition and management of lipohypertrophy can lead to rapid improvement in glycemic control without changes in pharmacologic therapy.
