Approximately 90% of the diabetes community in Ireland use insulin pens to manage their diabetes. A study published in 2013 claims the two thirds of the injecting diabetes population has lipohypertrophy - BD Medical (Becton Dickinson) was involved in this the largest study of its kind.
Last week, on one of my multiple trips to Dublin I was invited to attend an engagement workshop and factory tour organized by BD Medical (Becton Dickinson) where the word lipohypertrophy came up multiple times.
BD Medical manufactures disposable insulin injection pen needles in their factory in Dun Laoghaire, Dublin. They also used to manufacture our hypodermic disposable syringes for those of you who may be old enough to remember mixing insulins.
There were three people with diabetes in the room of about 30 people and a number of clinicians. I brought my personal experience of living with diabetes and some general experiences I observe of my peers in real life and in the online community. But it was really interesting to hear from a diabetes nurse specialist and what she commonly and uncommonly sees in clinics and how they approach new patients and patients who are struggling with their diabetes management.
We took a break from “workshopping" to hear from Mike Smith, BD’s Clinical Marketing Manager, who presented an informative talk on lipohypertrophy, which is something BD is very passionate about and BD was instrumental in producing the Forum for Injection Technique (FIT) guidelines to reduce the risk of lipohypertrophy and to make sure you are getting the best out of your insulin delivery. Here is a more PWD friendly version of those guidelines.
Approximately 90% of the diabetes community in Ireland use insulin pens to manage their diabetes. This might be surprising considering all the chatter on social media relating to insulin pumps.
I have always assumed given how often we might inject ourselves with this potentially lethal drug that being taught to inject correctly would be a high priority with healthcare providers.
However, the Blanco et AL 2013 study sponsored by BD showed that lipohypertrophy was present in:
- 76.3% of Patients with Type 1 and
- 56.1% of patients with Type 2
This study determined that the reason for such high number of LH was concerns over injection technique. This was probably the “largest survey (the Injection Technique Questionnaire) ever done concerning insulin injection technique in more than 13,000 insulin-injecting people with diabetes from 42 countries.”
What is lipohypertrophy or LH?
“ Lipohypertrophy is a medical term that refers to a lump under the skin caused by accumulation of extra fat at the site of many subcutaneous injections of insulin. It may be unsightly, mildly painful, and may change the timing or completeness of insulin action.” https://en.wikipedia.org/wiki/Lipohypertrophy
What causes Lipohypertrophy?
“Repeated insulin injections in the same location can cause fat and scar tissue to accumulate.” Also caused by reusing the same needle more than once. The more you reuse your needles, the higher your chance of developing this condition. One study found that 46 percent of people who developed lipohypertrophy reused needles." From Healthline.com.
How does LH affects your insulin absorption?
“Areas of lipohypertrophy can cause delays in absorption of medication administered to the affected area, like insulin, which can result in difficulties controlling blood sugar.” From Healthline.com.
What is the Correct Injection Technique and why?
DiaTribe.org condensed the Mayo Clinic’s “Six Sets of Golden Rules to Assist With Implementation of the New Recommendations” into an easy to read page.
These Golden Rules include:
- Consider your needle length (4mm for pens, 6mm for syringes).
- Rotate injection sites
- Do not reuse needles.
- Don’t reuse needles.
- Prime your Pen before injecting.
- "Dial two units on your pen and then press the button to shoot some insulin into the air to make sure it works. This is called an “air shot” or “priming” the pen. If you do not see at least two drops of insulin after repeated priming, do not use the pen. This indicates there may be a problem. The cartridge could be empty or the pen may not be assembled correctly." From BD’s Using Insulin Pens and Pen Needle Guide.
DISCLAIMER - BD paid for my travel expenses and accommodation to enable me to attend this workshop and patient engagement event.
The aim of the workshop was to introduce the newly established Irish based research and development team to the world of living with diabetes, specifically type 1 diabetes. What are the challenges that we face every day, what living with diabetes is really like, etc.
In the grand scheme of my diabetes management preventing LH is not high on my priority list because beyond being aware that it exists and rotating my injection sites there doesn’t seem to be anything else I can do to prevent it.
