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Lumps and Bumps from Insulin Therapy

By Dr. Francine Kaufman

Chief Medical Officer

Posted:  1/17/2012 8:07 PM

Tags:

Here at Medtronic, we get a lot of questions from customers about the lumps and bumps that may appear at injection sites. So, here’s a Q&A on what these lumps are, why they occur and how to prevent them.

What are these lumps and bumps at my injection sites?
Lumps and bumps from insulin are called lipohypertrophy.  This is a medical word for a lump under the skin from an accumulation of fat at the site of many insulin injections. Scar tissue may also develop at the sites.

Why does this happen?

This happens due to the action of insulin on the fat cells. Insulin can actually cause fat cells to increase in size. It is generally seen when one uses the same area for insulin injection or infusion.  It happens most often in areas that are easiest to inject insulin or place infusion sets—on both sides of the belly button and on the sides of the thighs.

What happens when you have this?

You may notice a thickening of this skin and areas of lumps and bumps. This was more evident with the older preparations of insulin where the skin changes were more evident. The changes may be very subtle with the newer insulin analogs so it is important to actually feel the areas that you use to inject or infuse insulin. You want to firmly stroke the areas in a sweeping motion to feel for any lumps.

Does it affect your glucose control?

Infusing insulin into areas of lipohypertrophy can affect your glucose control. Insulin is not always well-absorbed in these areas. You may find that your glucose control is not what you expect it to be. The more damaged the area is the more likely it is that glucose control will be affected. Sometimes the areas of lipohypertrophy have damaged nerve endings and you don’t feel your infusion set going it at all. This is clearly a sign of a damaged area.

How is it prevented?

Rotate your infusion sites! It is important to use different sites to prevent lipohypertrophy. You might want to use a calendar or body map to be sure that you are rotating you sites frequently.  Avoid areas that have lipohypertrohy and allow them to heal before using them for your infusion site.

Editor’s Note: Please click here for information on the “Clock” or “M or W” site rotation methods.

Any other tips?

If you do discover areas of lipohypertrophy and move to new areas to place your infusion set you may need to test your glucose more frequently. Insulin is absorbed differently in different body areas and this may affect your glucose. If you have been using your abdomen (where insulin is absorbed the fastest) and start using your buttocks (where insulin is absorbed more slowly) you may see your glucose values change more slowly as well.

Comments

Sara

Posted on Tue Jan 17 20:19:01 GMT 2012

This is great! I had been putting my infusion sites on my "love handles" for a while because that was the easist location for me, and for a while, the most predictable. Well, I think I overused those sites because I started to have absorption issues. Now that it is winter and my sleeves are longer, I am having some good luck using the back of my arms.

Robin

Posted on Sat Feb 04 18:02:34 GMT 2012

I have been diabetic for 20+ years and was put on insulin pump therapy in October 2011. I have problems when a site works for the first day then it is as if I have no insulin working after that. I was told to only use my abdomen, so I can't change sites a lot, but, I am running out of sets from changing them so much to try to find a site that works. Any ideas?

Rachel

Posted on Mon Feb 06 04:13:57 GMT 2012

Robin, I have had an insulin pump for almost ten years and would love to know the answer to that. I believe I must now have lipohypertrophy. Two days ago I was trying to insert CGM and took it out because of pain and all the sudden discovering a large lump which has turned into a huge bruise and smaller lump. I go through spots that work for a while and then it is like they become "immune" so to speak. I wish I had an answer because when this happens I tend to get pretty upset.

Karrie

Posted on Fri Feb 10 21:40:00 GMT 2012

@Rachel I’m sorry to hear that. I’ve sent your comment to someone from our HelpLine team who will reach out to you shortly to try to help.

Teresa

Posted on Mon Mar 05 00:19:53 GMT 2012

I can relate to Robin and Rachel. I've been on a CGM since June 2009. I'm having trouble finding insertion sites. My abdomen isn't good for the CGM b/c of lipothypertrophy (I've been on a pump for 25 years) and I'm currently using my hips and upper buttocks for the CGM, but I'm really struggling with finding new places. Any suggestions? Has anyone used the thigh area for the CGM?

Karrie

Posted on Mon Mar 05 20:40:00 GMT 2012

@Teresa the Medtronic sensor is actually only approved for use in the belly area. For infusion sites, there are more approved options (arm, thigh, top of buttocks). You can find more about site rotation and selecting sensor and infusion sites here: http://www.medtronicdiabetes.net/support/insertion-site-management. And if you’re having trouble with lipohypertrophy, I’d definitely check in with your healthcare team. They’ll likely have additional guidance for you.

Kate

Posted on Thu Apr 18 11:41:28 GMT 2013

I do rotate my shots all the time, but it doesn't seem to matter where I give the shots it always leaves a bump and they hurt to touch..

Naomi

Posted on Thu Apr 18 21:58:14 GMT 2013

Kate, I’m sorry to hear that. This sounds like a great question for your healthcare team as they can give you the best advice to meet your individual needs. If you have any questions related to a Medtronic device, let me know and I can connect you with someone to help.

Nicole

Posted on Mon Apr 22 03:11:24 GMT 2013

I've only been using insulin for about a year and I only have this on my legs. However the areas bruise, the lump appears and it itches like crazy. I wonder if it's the type of insulin might also help. Instead of using synthetic insulin or animal based....I actually asked if I was allergic to the brand I was using. I know the body produces it naturally but it's not pure there are additives added to the medication. Could it be a problem like that?

Naomi

Posted on Mon Apr 22 15:50:33 GMT 2013

Nicole, I’m sorry to hear you’re experiencing this. However, I’m not qualified to give medical advice. This is a question best asked to your healthcare team as they can answer questions specific to you and your needs. If you have any questions about a Medtronic device, let me know and I’d be happy to connect you with someone.

Dale

Posted on Wed Apr 24 15:48:37 GMT 2013

Been on insulin since December, 12. Have had no real problems. But, now I have a lunp in my abdomen that has enlarged since noticed about 4 days ago. About the size of a quarter, from, originally about 1 inch long and 1/3 inch wide. Also redness on surface at the site. No pain

Naomi

Posted on Wed Apr 24 20:41:12 GMT 2013

Dale, I’m sorry to hear that. It sounds like you should consult your healthcare team as they can give you the best advice about this. If you have any questions related to a Medtronic device, let me know and I can connect you with someone.

CHARI

Posted on Tue May 21 09:06:52 GMT 2013

I have just started Insulin Injection . Is there an Ointment / Cream which can soften the Skin

Naomi

Posted on Tue May 21 20:44:06 GMT 2013

Hi Chari, I’m not qualified to give any kind of medical advice. I recommend that you ask your healthcare team as they can give you the best advice to meet your individual needs. If you have any questions related to your device, let me know and I can connect you with someone.

Barry Eckstein

Posted on Mon Jul 22 18:15:57 GMT 2013

Is there anything I can do to reduce or eliminate the bumps. I currently have bumps that are highly irritating.. I thought that if I use a heated damp towel on the area, that could do the trick.
Any ideas?

Naomi

Posted on Mon Jul 22 20:07:35 GMT 2013

Hi Barry, I’m sorry to hear that. This sounds like a great question for your healthcare team as they can give you the best advice to meet your individual needs. If you have any questions related to a Medtronic device, let me know and I can connect you with someone.

Lisa Pogue

Posted on Fri Sep 06 02:15:51 GMT 2013

I started using the insulin pump about the middle of July, 2013. For several years I have had insulin site reactions when I gave myself shots. Now I am having them where I insert the insulin into my stomach. Works great the first 20 hours, but then does not seem to absorb as it should. I've talked to my health care staff and no one seems to know what to do. I'm getting very frustrated because I love the simplicity of the pump. Where can I find some assistance. Everyone seems to be scratching their heads.

Naomi

Posted on Fri Sep 06 16:28:05 GMT 2013

Lisa, I’m sorry to hear you’re having a hard time. I’ll have someone from my team reach out to you shortly to see if there is anything we can do to help.

Angela De Decker

Posted on Wed Sep 18 13:46:19 GMT 2013

Been a type 1 diabetic for 58 yrs, on insulin pump for 3 yrs. I occasionally get bleeding when I take out the infusion set, the a bruise appears, goes away in a couple of days. I use the top of my legs for infusion, and top of my stomach area, and away around the belly part. I have used a message machine to work on the stomach area, which seems to help. I really like being on the pump because I hated taking 6 needles a day prior to pump. Have been involved in a lot of studies in the London, ON area over the years, doing a water/intake study now. Was involved in a long term study for having diabetes for so long at St Joseph's Hospital, in London. For having diabetes so long I really don't have too many problems, either than CKA, on a strict low sodium, potassium carb diet. I have always had an endocronist looking after my diabetes, and now a Kidney Specialist. I was a child when I got diabetes, have 4 children, none are diabetic.

Can you tell me what causes the bleeding and the itching.

Kelly

Posted on Wed Sep 18 14:09:36 GMT 2013

What about when you do change your insertion sites on a steady rotation and you skin GOES INWARD or SINKS????? One of my butt cheeks is soooo "dented" inward it is amazingly bad. It is starting on my upper thighs as well. Thanks!

Danielle Comiskey

Posted on Wed Sep 18 14:11:29 GMT 2013

Naomi only refers to someone else. Want to know, from someone who knows, how do we get rid of the large lump from all the injections??

Sue

Posted on Wed Sep 18 15:08:22 GMT 2013

I have been a diabetic all my life. Started using the insulin pump in 2000. I do the rotation every 3 days. My problem is not lumps but indentations(stomach, buttocks and thighs), this leaves no fat to put the infusion sets in. Any suggestions.

Gary

Posted on Wed Sep 18 15:57:01 GMT 2013

I've been using pumps for 12 years, and totally wasted my abdomen before being told about this issue. Now I avoid it completely, using my "love handles" on the side and back, my arms, on the outside down to about 4 inches above my elbow, and the inside of my thighs. I've had trouble with the outside of my thighs - sometimes ripping out the set when I pull my pants up. :-) I've found I can't use the fattest parts of my arms and thighs, as the insulin doesn't absorb very well. I have to find spots closer to the muscle tissue - just not too close!

Marsha Vick

Posted on Wed Sep 18 17:53:03 GMT 2013

I am a type 1 "Brittle" diabetic due to removal of my pancreas in November 2008. My readings go from low 50's to off the chart. I have been told I'm carb sensitive and insulin resistant. Sooo...what do I do? I do have a CGM, but it's rarely in sync with my actual reading. With being a Brittle diabetic...it alarms all the time, which gets on my nerves at times. Also....I am slim, very, very body fat, especially in the stomach area. I have used every inch that is available for a good spot for my infusion and CGM. I had a "Whipple" in 2008...hence the Type 1. Good sized "frown" scar and I can't get too close to that. Have tried outside my area but usually get "no delivery" alarms. Also, CGM many times will hit a vessel and bleed like crazy. Got any good ideas?

Robert

Posted on Wed Sep 18 23:38:25 GMT 2013

You would think with the advancement in therapies, there might be a solution to lipohypertrophy. Will Liposuction work? How about Ultrasound to disrupt the bumps? Are there any Laser technologies available?

Karrie

Posted on Thu Sep 19 15:10:44 GMT 2013

Angela and Gary, thank you both for your comments and I’m sorry to hear that you sometimes have trouble with your infusion sets. I’ll have our HelpLine team reach out to you both to try to help.

Kelly, Danielle and Sue, these sound like great questions for your healthcare team but our 24-Hour HelpLine Team would be happy to try to help too. I’ll have someone contact each of you shortly. In the meantime, you might find this blog on new infusion site locations helpful: http://www.loop-blog.com/apex/Blog_Full_Post?id=a09C000000PcDEZIA3

Marsha , I’m sorry you’ve had trouble with your CGM. I’ll have someone from our HelpLine Team reach out to you as well.

Dyanna

Posted on Fri Sep 20 02:47:02 GMT 2013

I saw this article, and was curious....I only have used my stomach for past 15 years I have bruising and lots of scars but the hardening doesn't occur, just rotate on a larger scale....I have use almost every spot till my love handles reach my spin...it's better to have correct medication then have to waste equipment, and time.

Cathy

Posted on Fri Sep 20 14:30:03 GMT 2013

Read these emails and thought I would make a comment. I have been on pump therapy for 28 1/2 years. I too have some of these issues, but they go away after a few days. I think the bleeding is caused when we hit a small capillary under the skin. Use a tissue to stop the bleeding, but if it continues a bandadi works just as well. amy best advice for everyone is find an Insulin Pump group that meets xregularly with a Diabetes Nurse Educator. Many of your problems will be answered by others who have found simple solutions. I live outside of the Chicgo area and the group meets at Elmhurst Hospital the first Tuesday of the month. We would love to see some new faces if you live close. We also have specialsits who come to tell us about the latest things related to pump therapy or our health. I change my sites every two days as I learned the insulin crystalizes in the tubing. Good luck with your therapy. I would like to have one month "off" when I didn't have to think about blood sugars and where my pump is located. I do not use the CGM at this time, but have been thinking more about it. Again, good luck.

Karrie

Posted on Fri Sep 20 17:41:29 GMT 2013

Interesting question Robert! This is definitely not my area of expertise, but perhaps someone on your healthcare team can help you find an answer?

Naomi

Posted on Sat Sep 21 00:07:25 GMT 2013

Thanks for sharing Dyanna and Cathy, we understand that all of our customers have individual experiences and we're glad you’ve found what works for you.

Betts

Posted on Sun Sep 22 03:38:18 GMT 2013

Have had diabetes for 47 years, on the pump for 4 yrs. Have much scar tissue in abdomen so have moved to my sides & changed to a sure-T infusion set. Have Polymyalgia Rheumatica for 4 yrs & consequently due to pain , can't do it myself so my husband has to do it. Am running out of places there. Also have degenerative disc disease & just got a back brace which does not get along with the infusion sets. Any suggestions would be helpful.

Naomi

Posted on Mon Sep 23 17:00:28 GMT 2013

Hi Betts, I’m sorry you’re experiencing these problems. I’ll have someone from our 24-Hour HelpLine team contact you to see if there is any way we can help.

joseph

Posted on Sun Oct 06 19:17:14 GMT 2013

if i used my bottom my bloods go very high if i used my thighs the same thing happens
the only place i can use stomach i have keep move it around

IYUNAA

Posted on Sun Dec 29 01:22:40 GMT 2013

I have been a type 1 diabetic since I was 17 mths old. I am now 20yrs old and have started noticing lumps n my abdomen area. I have been messaging them, dieting, exercising, etc, and can't seem to get rid of them. I sometimes hate my body, because my body frame is small but there's two big lumps on each side of my stomach. I been on web sites and still no one has an answer to my question, which is "How can I get rid of these lumps"?

Joel

Posted on Thu Jan 02 00:06:00 GMT 2014

Hi Iyunaa. I am sorry to hear about the reoccurring lumps on your abdomen area. For information on site rotation and location for your infusion sets, check out our website at http://www.medtronicdiabetes.com/customer-support/insertion-site-management/infusion-placement. I would like to connect you with a member from my team to discuss this with you, so will have someone follow up with you soon.

Mistie

Posted on Fri Apr 11 23:02:45 GMT 2014

I have juvenile diabetes. Diagnosed when I was 18 months old. I am now 21 years old and have been on the insulin pump since I was 8 years old. I try to rotate my insulin site as much as possible, but it always itches severely when I put the site in my arm or leg, so I have to stick to putting it in my stomach or bottom. I have had these very small bumps that almost look like goosebumps in the areas I put my site in. They do not itch and are not puss filled. However, I am very self conscious about them. I was wondering if they are related to an allergy to the infusion set, are simply scarred tissue, or what?

Joel

Posted on Fri Apr 11 23:27:36 GMT 2014

Hi Mistie, I'm sorry that you experience some uncomfortableness when rotating your sites. I will have a member of my team reach out to you to offer any suggestions to try to help. You may want to talk to your healthcare team regarding the bumps you're concerned about. They'll be able to best address your questions and needs.

Ana

Posted on Wed Apr 16 05:51:27 GMT 2014

Can these lumps or bumps affect if you are pregnant? It is the first one I get and didnt knowwhat it was so I panicked a bit but reading this helped a bit to clam down. Guess will discuss at my next dr visit.

Joel

Posted on Wed Apr 16 15:57:32 GMT 2014

Hi Ana. I agree, it’s a question best asked to your doctor, as they can give you the best advice to meet your individual needs. If you have any questions related to your Medtronic device, let me know and I can connect you with someone.

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