Sister has severe lipohypertrophy (not on pump).. advice?

My sister was only injecting herself in her abdomen and now has severe lipohypertrothy. It didn’t help that she also gained weight and bought loser clothes to hide her changing body. As a right-hander, her right abdomen is all hills and valleys while the other side is lumpy too but generally looks more typical.

Background: We thought she must have a hernia, but she didn’t have any pain. Finally, after two years and the problem getting much worse, she finally mentioned this to her doctor. Doctor could feel scar tissue, but sent her to a specialist. The second doctor advised a radiologist who gave her barium and he finally discovered the problem.

Now my sister is giving herself shots in her legs and butt area, etc but she still creates lumps wherever she injects. The mounds of scar tissue on her abdomen haven’t decreased either. Suggestions / advice?

Is she injecting large dose of long-acting once a day, and short for meals?

The larger dose injections are more likely contributing to problem. Splitting single large dose to multiple locations may help.

When I started injections (1965), I did single daily Lente for almost 20 years, in my legs. This resulted in lipohypertrophy. But then switched to MDI NPH + Reg, and injected in abdomen, each being much smaller doses. Took a few years, but my legs finally recovered.

There are treatments that can surgically remove/reduce it.


I think the simple thing is to just use different areas, and make sure she uses her left hand more too.

You can use areas like the upper thigh (near the hip), the back of the calf, the shoulders, and lower back.

Depending on how much insulin she uses, another thing that might help is to switch to the higher concentration of rapid and basal insulin, so she uses less volume.

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I think these are injections per meal, but glad to know there’s a difference when injecting larger vs smaller doses. I’ll suggest that. Also really happy to hear you recovered.

A higher concentration of regular insulin? I think she uses Humalog R.

I use Toujeo for my basal, maybe she should consider that instead of whatever she uses, like Levemir or Lantus. I think the Toujeo is a higher contraction.

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Its larger doses and how long acting it is.

Meal time insulin is usually smaller doses of shorter acting, so out of system quicker.

Does she use long acting such as tresiba, lantus, levemir ? They can be delivered using a pen, so can use more concentrated U200 for example, for 1/2 the volume of insulin for same number of units.

Has her doctor suggested these alternatives or have reasons not to?

Yes, Toujeo is more concentrated. So you would inject less volume.

In the same way, with U200 versions of Humalog, you would need to inject less volume. It would be half the amount.