Lipohypertrophy is a lump under the

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...

caused by accumulation of extra fat at the site of many

subcutaneous injection Subcutaneous administration is the insertion of medications beneath the skin either by injection or infusion. A subcutaneous injection is administered as a bolus (medicine), bolus into the subcutis, the layer of skin directly below the dermis and ...

s of

insulin Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the insulin (''INS)'' gene. It is the main Anabolism, anabolic hormone of the body. It regulates the metabol ...

. It may be unsightly, mildly painful, and may change the timing or completeness of insulin

action Action may refer to: * Action (philosophy), something which is done by a person * Action principles the heart of fundamental physics * Action (narrative), a literary mode * Action fiction, a type of genre fiction * Action game, a genre of video gam ...

. It is a common, minor, chronic complication of diabetes mellitus. Typical injection site hypertrophy is several inches or centimeters across, smoothly rounded, and somewhat firmer than ordinary subcutaneous fat. There may be some

scar A scar (or scar tissue) is an area of fibrosis, fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other Organ (anatomy), organs, and biological tissue, t ...

tissue as well, but the major component is

adipose tissue Adipose tissue (also known as body fat or simply fat) is a loose connective tissue composed mostly of adipocytes. It also contains the stromal vascular fraction (SVF) of cells including preadipocytes, fibroblasts, Blood vessel, vascular endothel ...

, as insulin exerts a

hypertrophic Hypertrophy is the increase in the volume of an organ or tissue due to the enlargement of its component cells. It is distinguished from hyperplasia, in which the cells remain approximately the same size but increase in number. Although hypertro ...

effect on adipose cells. To avoid lipohypertrophy, persons with

diabetes mellitus Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained hyperglycemia, high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or th ...

who inject insulin daily for an extended period of time are advised to ''rotate'' their injections among several areas (usually upper, outer arms, outer thighs, abdomen below and around the

umbilicus Umbilicus may refer to: *The navel or belly button *Umbilicus (mollusc), a feature of gastropod, Nautilus and Ammonite shell anatomy *Umbilicus (plant), ''Umbilicus'' (plant), a genus of over ninety species of perennial flowering plants *Umbilicus ...

, and the upper parts of the buttocks). Rotation charts are often provided as part of diabetes education to help prevent lipohypertrophy. Lipohypertrophy usually will gradually disappear over months if injections in the area are avoided. It is a common misconception that the lump is largely scar tissue, as injection site hypertrophy is much rarer and milder with injections of other hormones and medications which lack the specific ability of insulin to stimulate adipose hypertrophy. In a sense, the "opposite" of injection site lipohypertrophy is injection site

lipoatrophy Lipoatrophy is the term describing the localized loss of fat tissue. This may occur as a result of subcutaneous injections of insulin in the treatment of diabetes, from the use of human growth hormone or from subcutaneous injections of copaxone u ...

, in which the subcutaneous fat around an injected area "melts away" over a few weeks or months, leaving unsightly, well-demarcated depressions in the skin. The mechanism of this local lipoatrophy is not understood and may involve autoimmunity or local inflammation.

See also

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Further reading