Perspectives on Diabetes Care

This is the official blog of the Association of Diabetes Care & Education Specialists where we share recent research and professional opinions on diabetes care and education.


Explore Helpful Views on Diabetes Care & Education

If you're looking for professional opinions on diabetes care and education, you're in the right place. Perspectives on Diabetes Care is the official ADCES® diabetes care and education blog that shares helpful views on diabetes care and education. 

This is where you'll find practical tips on working with people affected by prediabetes, diabetes and related cardiometabolic conditions and the latest research and viewpoints on issues facing diabetes care and education specialists and the people they serve.



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Lipohypertrophy: A Forgotten Problem

Jan 28, 2020, 09:02 AM

By Melanie Teslik, BC-ADM, CDE, MS, RN

As we continue to increase the use of technology in diabetes care and transition to pumps and CGM with shorter needles, one major issue lingers: have we forgotten about lipohypertrophy?  

Lipohypertrophy, the thickening of tissue around injection sites, is still a major issue for people with type 1 or type 2 diabetes. Studies show that as many as 62% of your clients might be affected. However, when I mention it to others, many individuals look at me as if this cannot be a problem with current technology. Unfortunately, that’s simply not true. As diabetes care and education specialists, we must understand how to inspect and palpate injection sites, and work with clients to minimize risk. 

The greatest complication from lipohypertrophy is the erratic absorption of insulin when the individual injects into affected areas. Depending on the amount and type of insulin used, absorption will be negatively impacted if injection continues without alternating sites. For those using long-acting insulins, it can remain at the site for even longer periods of time, further enhancing potential lipohypertrophy.  

What You Can Do to Minimize Risk 

When clients arrive for their appointment with glycemic variability, many providers will adjust the insulin dose immediately. However, when sites are simply rotated, there may be no need to adjust insulin. In fact, many times these same individuals will experience hypoglycemia when using alternate sites because absorption has been improved.   

The first step with any client should be to examine injection sites to see if they have developed lipohypertrophy. Examination of injection sites through palpation and inspection often finds the cause is from continuous injections at the same site or side of the body. Talk with them and find out why they might be using the same site.  

We need to remember to examine site selections at every visit and work with clients to understand their reasons for limiting site selection, because the consequences are very real. 

Clients will most often say they do this because “it doesn’t hurt” due to scar tissue in that area. Let them know that there are steps we can take to minimize pain when rotating sites. As diabetes care and education specialists, we have learned to use the shortest needle possible. While this does not solve the problem, it does encourage the client to try alternate sites since it hurts less or not at all.  

Our clients are at greater risk for developing lipohypertrophy than ever before. We need to remember to examine site selections at every visit and work with clients to understand their reasons for limiting site selection, because the consequences are very real. There are only so many areas for a client to inject on their body, so to lose one site places the remaining areas at risk.  

For more information on insulin injection techniques, including free tip sheets for your clients, visit  

ADCES Perspectives on Diabetes Care

The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.

Copyright is owned or held by the Association of Diabetes Care & Education Specialists and all rights are reserved. Permission is granted, at no cost and without need for further request, to link to, quote, excerpt or reprint from these stories in any medium as long as no text is altered, and proper attribution is made to the Association of Diabetes Care & Education Specialists.

HEALTHCARE DISCLAIMER: This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your diabetes care and education specialist or healthcare provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. To find a diabetes care and education specialist near you, visit