FIT Technique Plus* Lipohypertrophy

What is lipohypertrophy?
Lipophyertrophy is present at the injection sites of many people who inject insulin. Lipohypertrophy, sometimes referred to a lipo, is a thickened rubbery area of fat tissue that can grow and develop in the subcutaneous fat where injections of insulin are given. Areas of lipohypertrophy vary greatly in size and are often felt more easily than seen.4 Regular site injection should be a normal part of your injection routine. To check your injection site, feel the area where you normally inject. Look for puffiness, raised areas and redness. Feel for hardness or lumpiness. If it is difficult to see your injection sites, a mirror may help.

*Educational tools based on FIT Canada Recommendations for Best Practice in Injection Technique.

Did you know?

Lipohypertrophy can be prevented. The risk of developing lipohypertrophy increases with repeated injections into a small area less than the size of a postage stamp.3 Areas for injection should be at least the size of a postcard and each injection should be rotated within the area, spaced at least one finger width apart.5 In other words, dont inject in exactly the same point each time. Your doctor or diabetes educator can recommend a structured site rotation plan that will work for you. This will involve rotation between injection sites and within injection sites.

Did you know?

Lipohypertrophy has also been associated with needle reuse. Needles should be used only once (and then disposed of in an approved sharps container.)5
New needle

An area of lipohypertrophy can affect your blood glucose control. Injecting into an area of lipohypertrophy can cause irregular insulin absorption and have an impact on your blood glucose readings.2 Talk to your doctor or diabetes educator if you think you have lipohypertrophy at your injection sites.

Reused needle

At x 370 magnification

1. Vardar B, Kizilc S. Incidence of lipohypertrophy in diabetic patients and a study of influencing factors. Diabetes Res Clin Pract 2007; 77:231-236. 2. Johansson UB, et al. Impaired absorption of insulin aspart from lipohypertrophic injection sites. Diabetes Care 2005;28(8):2025-7. 3. De Coninck C, et al. Results and analysis of the 2008-2009 Insulin Injection Technique Questionnaire Survey. J Diabetes 2010;2(3):168-79. 4. Frid A, et al. New injection recommendations for patients with diabetes. Diabetes & Metabolism 2010; 36: S3-S18. 5. Berard L, et al. FIT Forum for Injection Technique Canada. Recommendations for Best Practice in Injection Technique. October 2011.

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FIT Technique Plus* Needle Length

Did you know?
Insulin is best absorbed in the subcutaneous layer Insulin injected into the muscle will not be absorbed properly. It may be painful and could be the cause of low or high blood sugars.
Skin Subcutaneous tissue

*Educational tools based on FIT Canada Recommendations for Best Practice in Injection Technique.

4mm needle

NOT Here

HERE

Muscle

NOT Here

Did you know?

Needles come in many lengths from 4mm to 12.7mm long. New research of the skin shows that on average the skin is only 1.6-2.4mm thick in all people living with diabetes.1, 5
1

12.7mm x 29g

This means that 4, 5 and 6mm needles are suitable for all people living with diabetes who inject.4

8mm x 31g 6mm x 32g 5mm x 31g 4mm x 32g

4
* *

6
Needles actual size

Did you know?

How you inject your insulin matters If you choose to use longer pen needles or syringes, or if you are extremely lean, you may need to perform a skin lift in order to avoid injecting into the muscle. Review your injection technique with your doctor or diabetes educator today.

1. Gibney MA, et al. Skin and subcutaneous adipose layer thickness in adults with diabetes at sites used for insulin injections: implications for needle length recommendations. Curr Med Res Opin. 2010; 26 (6): 1519-1530. 2. Hirsch LJ, et al. Comparative glycemic control, safety and patient ratings for a new 4mm x 32G insulin pen needle in adults with diabetes. Curr Med Res Opin 2010;6:1531-41. 3. Hofman PL, et al. Defining the ideal injection techniques when using 5-mm needles in children and adults. Diab Care. 2010;33(9) 1940-1944. 4. Berard L, et al. FIT Forum for Injection Technique Canada. Recommendations for Best Practice in Injection Technique. October 2011. 5. Lo Presti D, et al. Skin and subcutaneous thickness at injecting sites in children with diabetes: ultrasound findings and recommendations for giving injection. Ped Diab 2012;13(7):525-53. * The needles sizes are for illustrative purposes only and do not reflect the actual size.

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FIT Technique Plus* Making Injections more Comfortable

Did you know?
Injectable therapy is an option to treat diabetes and can help you achieve better blood glucose control. Over the years needle technology has improved. Some pen needles are shorter, finer and have extra thin wall technology. These improvements all make injecting more comfortable than you might think. Injection technique also matters. When done properly, injections can be virtually pain free. If you are new to injecting, ask your educator to demonstrate proper technique using a pen and a shorter, finer pen needle.

*Educational tools based on FIT Canada Recommendations for Best Practice in Injection Technique.

Top tips for comfort4

1 Keep injectable therapy in use at room temperature. 2 Use a new needle each time. 4 Inspect and palpate the skin prior to each injection to ensure injection site is healthy. 5 Inject solution slowly and evenly. 6 Avoid using alcohol to swab skin, but if used, inject only after it has dried completely. 7 Avoid injecting into hair roots, scars and moles. 8 Avoid injecting though clothing. 3 Use shorter needles and smaller diameter.

9 If the volume of your injection is uncomfortable, talk to your doctor about how to divide into 2 injections.

4mm x 32G

5mm x 31G

6mm x 32G tip Needles actual size

Did you know?

Shorter needles means a reduction in anticipation of pain and in actual injection pain.1 Bleeding is more likely to be associated with injection pain; smaller diameter needles cause less bleeding, therefore less pain.1

Recommended reading Injection technique resource: http://www.bd.com/ca/diabetes/english /page.aspx?cat=14501

1. Aronson R. The Role of Comfort and Discomfort in Insulin Therapy. Diabetes Technology & Therapeutics. April 2012;14(8):1-7. 2. Hirsch LJ, et al. Comparative glycemic control, safety and patient ratings for a new 4mm x 32G insulin pen needle in adults with diabetes. Curr Med Res Opin 2010;6:1531-41. 3. Hirsch LJ, et al. Impact of a Modified Needle Tip Geometry on Penetration Force as well as Acceptability, Preference, and Perceived Pain in Subjects with Diabetes. J Diabetes Sci Technol 2012;6(2):328-335. 4. Berard L, et al. FIT Forum for Injection Technique Canada. Recommendations for Best Practice in Injection Technique. October 2011.

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FIT Technique Plus* Site Selection & Site Rotation

Did you know?
The preferred areas to inject are: abdomen thighs buttocks
abdomen thigh buttocks

*Educational tools based on FIT Canada Recommendations for Best Practice in Injection Technique.

The back of the arm may also be used but you may need help in order to reach the correct area.
back of arms

Did you know?

A structured rotation pattern includes rotation between injection sites and within an injection site. For example, 1. Divide your abdomen injection area into 4 areas. 2. Divide each area into smaller sections. Use only one section each week. 3. Rotate within that section, in a circular pattern, with the next injection being 2-3cm from your last. 4. Rotate to the next section the following week, etc.
4. 3.

rotate the site you use

1. 2.

rotate within the site you use

1.

2.

4.

3.

Did you know?

Risk of lipohypertrophy, at your injection sites is higher when you don't change injection sites often. Injecting into an area of lipohypertrophy may keep your insulin from working the way it should. Thats why its important to rotate properly and check your site before you inject. Steps for site inspection: 1. Stand up and feel the area where you normally inject. 2. Look for puffiness, raised areas, redness, hardness or lumpiness. 3. Discuss any concerns with your doctor or diabetes educator. Its all about keeping your injection sites healthy. Establish a routine and keep track!

My Site Rotation Plan

There are many examples of how to rotate your injection sites. Your diabetes educator can assess your sites, or real estate to help you design a site rotation plan that will work best for you. See next page for an example of an injection site rotation plan.

1 Vardar B, Kizilc S. Incidence of lipohypertrophy in diabetic patients and a study of influencing factors. Diabetes Res Clin Pract 2007; 77:231-236. 2 Johansson UB, et al. Impaired absorption of insulin aspart from lipohypertrophic injection sites. Diabetes Care 2005;28(8):2025-7. 3 Cureu B, et al. VDBD Guide: The injection in diabetes mellitus. (written in German), May 2011. 4 Brtsch U, et al. Injectable therapy Pen Devices for treatment of diabetes (article in German). Ther Umsch 2006; 63: 398-404. 5 Patton SR, et al. Survey of Insulin Site Rotation in Youth With Type 1 Diabetes Mellitus. J Pediatr Health Care 2010; 24: 365-371. 6 Berard L, et al. FIT Forum for Injection Technique Canada. Recommendations for Best Practice in Injection Technique. October 2011.

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FIT Technique Plus* Site Selection & Site Rotation

My Site Rotation Plan

*Educational tools based on FIT Canada Recommendations for Best Practice in Injection Technique.

Notes

Supported by BD Medical - Diabetes Care 06 -2013

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