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07-11-2006, 01:25 AM
The doctors used to check my injection sites when I was young, but after four years or so it seems they stopped. Mostly they just asked to see if there was any hardening from scar tissue, and I could always confirm that there was not. When I was first diagnosed (9 years ago), they mentioned fat pockets and depressions in the skin but not why they're bad and certainly didn't emphasize them the way they did scar tissue.
Probably for the last two if not three years, I've developed hypertrophy on my stomach (either side of my navel) and on both sides of my hips. Since I had sensitive arms and blood-vessely legs :rolleyes: I only "rotated" between the four spots. I figured the fat deposits developed from injecting insulin, but they're the most discreet places and especially less painful, what with fat blobs having no real nerve endings, so I just continued to inject there... :hypocrite:
NPH being old-school like it is, I've been trying to get an appointment with my endocrinologist to see about switching over to something like lantus or levemir, and with the release of my latest not-so-great A1C, I decided it was time to refresh my education. Nine years ago was a long time! (Not to mention I was only 11) and it seems that hypertrophy has quite the impact on one's ability to control glucose levels. I found this interesting study:
http://bmj.bmjjournals.com/cgi/content/full/327/7411/383
The most notable bit being:
A 37 year old woman had been given a diagnosis of type 1 diabetes when she was 7 years old. She was treated with soluble insulin twice daily. She was transferred to our diabetes unit in 2000. She had experienced problems with fluctuating blood glucose concentrations, recurrent hyperglycaemia, and frequent unpredictable hypoglycaemia, despite compliance with diet and regular self monitoring of blood glucose. At her most recent annual review she was noted to have mild background retinopathy but no other microvascular or macrovascular complications of diabetes. Results of lipid, urea and electrolytes, and thyroid function tests were normal, but her glycated haemoglobin was 9.1% (normal range 3.6% to 5.1%). She was treated with Human Actrapid (Novo Nordisk) at a total daily dose of 30 units a day and Human Insulatard (Novo Nordisk) 26 units at night, both administered through a pen device. After her latest annual review she was referred to the diabetes specialist nurse for further follow up in an attempt to improve her glycaemic control.
The diabetes specialist nurse noted that she had fluctuating blood sugar concentrations, ranging from 2.0 mmol/l to 18.9 mmol/l, and unpredictable hypoglycaemic episodes occurring three or four times a week, with good awareness. The nurse reviewed her injection technique and noted significant lipohypertrophy at the sites of her abdominal injections. She was advised to avoid these sites for future injections and to reduce her insulin dose by 10%. Over the next six months her glycaemic control improved, with home tests showing blood sugar concentrations ranging from 3.4 mmol/l to 9.8 mmol/l before meals and 6.7 mmol/l to 12.3 mmol/l after meals. The frequency of occurrences of hypoglycaemia reduced to less than once a month. Her glycated haemoglobin fell to 6.8% within three months, despite the reduction in insulin dose.
I've now sucked it up and am avoiding these places completely. Legs, butt, arms are it now. They bruise and bleed and hurt but hopefully they'll give better control, and additionally, I hope those fat pockets will dissapear if only for vanity's sake. My question is (gosh this is long :flute: ) , what experience have you had with hypertrophy going away? I read a study that suggested it takes up to a year or more, but one seemed to say (though inconclusively) that in almost half the cases it never goes away!
Probably for the last two if not three years, I've developed hypertrophy on my stomach (either side of my navel) and on both sides of my hips. Since I had sensitive arms and blood-vessely legs :rolleyes: I only "rotated" between the four spots. I figured the fat deposits developed from injecting insulin, but they're the most discreet places and especially less painful, what with fat blobs having no real nerve endings, so I just continued to inject there... :hypocrite:
NPH being old-school like it is, I've been trying to get an appointment with my endocrinologist to see about switching over to something like lantus or levemir, and with the release of my latest not-so-great A1C, I decided it was time to refresh my education. Nine years ago was a long time! (Not to mention I was only 11) and it seems that hypertrophy has quite the impact on one's ability to control glucose levels. I found this interesting study:
http://bmj.bmjjournals.com/cgi/content/full/327/7411/383
The most notable bit being:
A 37 year old woman had been given a diagnosis of type 1 diabetes when she was 7 years old. She was treated with soluble insulin twice daily. She was transferred to our diabetes unit in 2000. She had experienced problems with fluctuating blood glucose concentrations, recurrent hyperglycaemia, and frequent unpredictable hypoglycaemia, despite compliance with diet and regular self monitoring of blood glucose. At her most recent annual review she was noted to have mild background retinopathy but no other microvascular or macrovascular complications of diabetes. Results of lipid, urea and electrolytes, and thyroid function tests were normal, but her glycated haemoglobin was 9.1% (normal range 3.6% to 5.1%). She was treated with Human Actrapid (Novo Nordisk) at a total daily dose of 30 units a day and Human Insulatard (Novo Nordisk) 26 units at night, both administered through a pen device. After her latest annual review she was referred to the diabetes specialist nurse for further follow up in an attempt to improve her glycaemic control.
The diabetes specialist nurse noted that she had fluctuating blood sugar concentrations, ranging from 2.0 mmol/l to 18.9 mmol/l, and unpredictable hypoglycaemic episodes occurring three or four times a week, with good awareness. The nurse reviewed her injection technique and noted significant lipohypertrophy at the sites of her abdominal injections. She was advised to avoid these sites for future injections and to reduce her insulin dose by 10%. Over the next six months her glycaemic control improved, with home tests showing blood sugar concentrations ranging from 3.4 mmol/l to 9.8 mmol/l before meals and 6.7 mmol/l to 12.3 mmol/l after meals. The frequency of occurrences of hypoglycaemia reduced to less than once a month. Her glycated haemoglobin fell to 6.8% within three months, despite the reduction in insulin dose.
I've now sucked it up and am avoiding these places completely. Legs, butt, arms are it now. They bruise and bleed and hurt but hopefully they'll give better control, and additionally, I hope those fat pockets will dissapear if only for vanity's sake. My question is (gosh this is long :flute: ) , what experience have you had with hypertrophy going away? I read a study that suggested it takes up to a year or more, but one seemed to say (though inconclusively) that in almost half the cases it never goes away!