Lipohypertrophy question

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Mumpie_olgran

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Type 1
Hi
I do try and vary my injection sites but not overly scientific about it. This morning I can feel a firm (but not hard) small lump which I'm guessing is lipohypertrophy because it is in an area which gets a lot of needle traffic being just below my tummy button.
Question is does anyone know if it's right approach to sort of massage it away? Or better to leave it to settle
Thanks all in advance
 
Hi, I could be wrong, but I see you’ve only been diagnosed a few months therefore I’d be surprised if it’s lipohypertrophy, I would have thought that would taken a little longer to develop. (But as I say, I could be wrong, especially if you are using the site a lot?)

Do you inject quite close to your tummy button? I believe the guidance is to leave 2 inches around it in a circle. If you’ve gone a bit close recently perhaps it has got a bit inflamed - I know sometimes I get lumps and bumps after injecting, I suppose it depends what you ‘hit’ with regards to the tissue when coming in and out.

If it were me I would leave it and see if it goes down over the weekend (as injection related lumps often do for me), if not I’d maybe then contact my dsn or something if I was still worried. But as I say, I’d be super surprised for it to be that so early on - however others have more and different experiences to me, so I may not be correct!
 
Thank you pawprint. It's so helpful that people reply quickly on this forum
You're right, I'm new to this and hypertrophy is just a guess. I do rotate sites a fair bit using thighs, sometimes calves but the tummy does get some traffic just because I find it more discreet when at work
I'm probably pretty close to bang on two inches with this particular spot although good to hear that's the minimum guideline as I am often closer to the bullseye. So I can change that now

OK I'll sit tight for the weekend at least and see how it settles. There was actually a small droplet of blood when I injected so maybe that points to something else anyway

Appreciate the response thank you
 
Mumpie_olgran said:
I'm probably pretty close to bang on two inches with this particular spot although good to hear that's the minimum guideline as I am often closer to the bullseye. So I can change that now
Appreciate the response thank you
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I think it might actually be 2cm, apologies for the wrong measurement system I had not long woken up :rofl:

But you’re very welcome, I know from experience this forum is happy to help with anything. If there was a bit of blood then I would suspect it may be a bruise, that happens to me quite often when I inject in my stomach (I am guessing you are perhaps quite slim having been in DKA, sometimes I wonder if how much fat you have in an area has something to do with it!).
 
About a month before my DAFNE course we had an introductory morning. The DSN running the course checked each of us for 'bad sites'; I had 2, one on each upper thigh a zone I was repeatedly and lazily (it was easy access) using for my once daily basal. I was advised to stop using that zone for 3 months, which I did and 3 days later I realised that my Tresiba was too great and I reduced from 10 units to 9.5 daily, now 9.

Another attendee also had a 'bad site' and he was using Levemir. He got an immediate gain from his basal, but only waited 6 weeks and then started reusing that site - his log book showed that his Levermir was no longer as effective. So 3 months seems the right guidance. The DSN also said no point in massaging or similar. Time was the best healing solution, but cold packs can help if such zones are painful. I've since seen that the Plymouth diabetes service recommends 2-3 months of not using such sites.
 
Yes you're right. For all the things I do have to consider on health, I'm lucky enough that being overweight hasn't ever featured among them. And DKA put me near two dimensional...so I do need to work quite hard to find a receptive and fresh site

It doesn't really feel like a bruise in the conventional sense ie of having taken a knock as they don't protrude. But I'm not really worried about it and will just see how it settles from here
 
I find I sometimes get a pleb for want of a better term when I inject and it is usually when I have hit a tiny capillary with the needle and it has bled under the surface causing a small pocket of blood. Often you can feel it but not see it at the time, but the bruise will usually develop in a couple of days or so as the blood dissipates.

I too would be very surprised if this is lipohypertrophy at such an early stage.

Really surprised that you inject into your calves especially if I am right in interpreting your post as you being slim. I haven't heard calves mentioned before as a suitable injection site. They just seem like quite a muscly spot to go for but perhaps that is just my mental prejudice.
 
Again appreciate the replies and insights. Reasoning on using the calf was that for me the back of the calf is pretty similar feel texture-wise to the outer thigh which seems to be a fair game. I am pretty scrawny but I'm no Bradley Wiggins on leg muscle above or below the knee really.

And the second reason is that I just find it easier to do reasonably discreetly in the calf, for example if I'm on public transport or at work (in an office)

But I really don't have any great need to stick to the calf and will bow to the forum's greater experience if there are views it could come at a cost. @rebrascora do you think there's downside to the calf or are you being quite literal when you express surprise? Both are fine, just checking
 
I have just had a quick web search and I can't find a diagram of insulin injection sites where calves are suggested/indicated. It may be because there is a risk of hitting muscle, perhaps because this area does not always carry as much subcutaneous fat as other recommended areas. If it is working for you then feel free to continue but do be aware that if you hit muscle it will probably hurt more and will almost certainly get into your blood stream significantly and probably unpredictably quicker. I know we dream of a fast acting insulin which really is actually fast as oppose to NovoSluggish etc, but I think the unpredictability of hitting muscle one one occasion and not on another is probably the reason it is avoided. Maybe small corrections might be OK in such areas but perhaps not larger boluses where the insulin might hit you faster than you could eat to counter it.
These are just my thoughts and may not reflect the true situation. Perhapsyou could start a new thread about injecting into calves to get more specific input from others on the subject.
 
Mumpie_olgran said:
Again appreciate the replies and insights. Reasoning on using the calf was that for me the back of the calf is pretty similar feel texture-wise to the outer thigh which seems to be a fair game. I am pretty scrawny but I'm no Bradley Wiggins on leg muscle above or below the knee really.

And the second reason is that I just find it easier to do reasonably discreetly in the calf, for example if I'm on public transport or at work (in an office)

But I really don't have any great need to stick to the calf and will bow to the forum's greater experience if there are views it could come at a cost. @rebrascora do you think there's downside to the calf or are you being quite literal when you express surprise? Both are fine, just checking
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I too am "pretty scrawny"-- diagnosed 8 months ago and still struggling to get my BMI back up to 18-- and would definitely not inject in the back of the calf! Even us scrawnies are likely to have a teensy bit of subcutaneous fat on the thigh, but you're unlikely to have much of any on the calf.

Have you tried the top of the behind? Not too inaccessible? Just wear builder's trousers ...
 
Arms are very accessible too although not always discreet. The area you insert your Libre into is also indicated as a site for insulin.
 
I'm very happy to try a few more sites and see.

I might be misremembering but I think I saw something about people sometimes choosing to inject directly into muscle in order to get quicker effects maybe? Not that I'm particularly looking to quicken the insulin but presumably that would suggest it being OK to do so?
 
Mumpie_olgran said:
I'm very happy to try a few more sites and see.

I might be misremembering but I think I saw something about people sometimes choosing to inject directly into muscle in order to get quicker effects maybe? Not that I'm particularly looking to quicken the insulin but presumably that would suggest it being OK to do so?
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As far as I’m aware the reason they suggest the areas they do is because they don’t want you to inject into muscle - it means insulin is absorbed more quickly (and therefore not in the way it should be) and can increase the risk of hypos etc. Whilst injecting into muscle isn’t “dangerous” as such, insulin should be injected subcutaneously for best effects.
 
Mumpie_olgran said:
I'm very happy to try a few more sites and see.

I might be misremembering but I think I saw something about people sometimes choosing to inject directly into muscle in order to get quicker effects maybe? Not that I'm particularly looking to quicken the insulin but presumably that would suggest it being OK to do so?
Click to expand...
Personally, I’d never inject short acting into muscle, though I have read of some people doing so to bring their levels down quickly when they are high. You lose the 4 hour action of the insulin, so you’ll probably still be digesting the food when the insulin has ceased to have effect.
You should never EVER inject Lantus into muscle, because you lose the action that spreads the absorption over 24 hours (something to do with the slightly acidic Lantus reacting with the alkaline Ph of the body, and crystallising out the insulin gradually), so you will get the whole dose into your system at once.
 
Got it, thanks. All well noted
 
DaveB said:
Hi. I also use the upper arm as suggested by my DN.
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Glad to read this - my DSN told me they advise against using the upper arm because of the increased risk of injecting into muscle these days - but I do plan on using it anyway! (Haven’t been brave enough to do so yet!)
 
pawprint91 said:
Glad to read this - my DSN told me they advise against using the upper arm because of the increased risk of injecting into muscle these days - but I do plan on using it anyway! (Haven’t been brave enough to do so yet!)
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If you think about it, the Libre filament is about the same length as an insulin needle and you don't put that into muscle, so the arm should be fine.
 
rebrascora said:
If you think about it, the Libre filament is about the same length as an insulin needle and you don't put that into muscle, so the arm should be fine.
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That was my thought too ... Thought it weird when I asked and was told not to use it!
 
rebrascora said:
I find I sometimes get a pleb for want of a better term when I inject and it is usually when I have hit a tiny capillary with the needle and it has bled under the surface causing a small pocket of blood. Often you can feel it but not see it at the time, but the bruise will usually develop in a couple of days or so as the blood dissipates.

I too would be very surprised if this is lipohypertrophy at such an early stage.

Really surprised that you inject into your calves especially if I am right in interpreting your post as you being slim. I haven't heard calves mentioned before as a suitable injection site. They just seem like quite a muscly spot to go for but perhaps that is just my mental prejudice.
Click to expand...
And there it is, bruise formed now and little pea lump has gone

Again thanks all
 
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