From the "crap no one ever tells you about with diabetes" file, comes:

 

Lipohypertrophy

 

Dissect the word with me for a moment:

Lipo -- OK, that sounds like weight loss surgery.

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Hyper -- Yes, we often are. How else could we juggle work, kids, exercise, myriad lab tests and doctor's appointments, non-stop carb-counting and dosing adjustments, etc., etc. and still do our taxes?

Trophy -- Do I get one, for putting up with all this diabetes crap?

Just because Wikipedia brushes this off as "common" and "minor," doesn't mean that at some point, it won't be the biggest thorn in your side (pun intended!) with diabetes. I personally have had ongoing skin issues with the adhesives for diabetes devices, and now that I'm regularly wearing both the OmniPod and new Dexcom sensor again, I am feeling like Public Pin Cushion No. 1! I'm not sure which is less sexy: these two chunks of plastic hanging off my body, or the black-and-blue-and-yellow track marks I now sport all over from where said chunks were formerly stuck:

 

dexcom and omnipod on belly

 

 

infusion site damage

 

It's really hard to find good information on lipohypertrophy, even from the vendors whose products clearly cause it regularly.

And how come it seems like so few patients are ever warned about skin issues at all, but just have to learn the hard way (pun again!) when scar tissue "rears its ugly head"? Then suddenly, it seems like we've got no good sites left... everything's lumpy and bruised, and our insulin absorption goes all to hell. My recent frustration, via twitter:

Amy patients tweet

To be fair, Roche has been the most proactive vendor on this topic. A few years ago, they even kicked off a "National Infusion Site Awareness Week" initiative to raise awareness about the importance of choosing your sites carefully. They shipped out a box of stuff to a bunch of bloggers that I still have sitting on my self -- lapel buttons, a boatload of temporary tattoos for infusion sites (which are cute, but I wear the OmniPod so no use to me), and a desk calendar to encourage us to keep written records of our site rotations. This was a valiant effort, I suppose, although it seemed to peter out after 2011. Roche spokesperson Rob Muller confirms that the company has dropped the campaign, although he wasn't sure why.

Luckily, on the Accu-Chek website you can still access something called "The Professionals Pocket Guide to Infusion Site Management," available in PDF. It's not all that pocket-ish at 41 pages, but it does include a good list of skin prep wipes, adhesive removal wipes, and lots of tips about rotating your sites. I'm sure Roche will indulge me in reprinting their visual guide to ideal rotation patterns:

Site rotation - AccuChek

They state that new sites should be at least: "2 inches (5 cm) away from a previous site, as well as 2 inches (5 cm) away from the belly button." OK, so I might be a bit sloppy on this. But just look at those images again -- like a geometry assignment for those of us math idiots already stumbling every day over carb estimations and correction factors. Talk about living up to being the ideal patient! I already use a ballpoint pen on my belly to mark the "inside spot" that shouldn't be slathered with SkinTac before my G4 sensor goes on (you gotta keep the point of insertion adhesive-free). I'm not about to start drawing zigzags and criss-crosses in permanent ink to remember where my pump last went!

While it's a great resource for general info, I shudder to think of endos and CDEs who might download this guidebook and do some finger-waving at their patients for not executing correctly.

To me, the most important bit in this booklet is on page 29, the part about preventing infection. Man, I wish I'd red that stuff before my first site infection hit!

It's good to see that community members are now producing some of their own ideas for site rotation reminders, such as the D-Mom we recently featured, Mary Anne DeZure and her "Time for Change" fridge magnet. This trumps writing it down in a desk calendar, but doesn't exactly otherwise change your life much.

What I REALLY want to know -- as I assume all us PWDs do -- is how to counteract this scar tissue problem once it occurs. Is there any way to rejuvenate the skin? That doesn't involve hundreds of dollars in spa treatments?

Googling it, treatment suggestions seem to include magnet therapy and accupuncture or accupressure -- or in extreme cases, a 2009 journal article suggests: "severe lipohypertrophy can be treated with liposuction surgery." Ewww, no thank you! Not to mention the battle over insurance coverage for that. Good luck!

So I queried Virginia Valentine, CDE and insulin pump expert, who's now on the medical advisory board for Tandem. She makes a differentiation between garden-variety scar tissue and this diabetes-related condition:

"Scar tissue is structurally different from the skin it replaces and doesn't have elasticity like normal skin and will not work for infusion set placement. This is just one of the reasons to avoid having an abscess that requires surgical debridement (aka precision laser removal).

"What most people think is scar tissue is actually insulin lipohypertrophy -- localized hypertrophy of subcutaneous fat at insulin injection sites, caused by the lipogenic effect of insulin. If you have a lump or thickened area, best treatment is to leave it alone. That is why all the info about site rotation. Most people over time find a few areas they are comfortable with, either for injection or pump sites, and end up with some hypertrophy. Usually hypertrophic areas after a few weeks get better, if it is really thickened maybe a few months. I have some patients who go on a pump vacation for a few months just to give areas a rest. This is not usually a problem in us folks with type 2 diabetes because we have more tummy to work with."

(I don't know about that last statement -- you be the judge)

But OK, we just need to let the affected area rest for a while. Thanks to Virginia for giving us the straight talk here. But this won't be easy for me, wondering where the heck am I going to stick my OmniPod and Dexcom G4 now that all the available "real estate" I have looks somewhat lipohypertrophic?!

To all the other medtech vendors who make stuff that sticks into patients' bodies, we could use some help here! See above tweet.

 

 

** UPDATE: 3/14/13 at 3:45pm **

 

Hey All, Mike just identified something that might be of great help avoiding liperhypertophy: Tartoos, patent-pending temporary tattoos that help you keep track of injection sites — wow!

See http://insulinnation.com/a-tattoo-even-mom-will-love/#.UUJKHTf5XHV

 

Tartoos diabetes

 

 
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