Insulin Lipohypertrophy — RACP Adult Medicine MCQ

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EasyEndocrinology & DiabetesInsulin LipohypertrophyRACP Adult Medicine

A 55-year-old man with type 2 diabetes on insulin develops a lipohypertrophic nodule at his injection site. He reports erratic blood glucose control. What is the key patient education point?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Apply ice before injecting

Lipohypertrophy develops from repeated insulin injection into the same site. It causes erratic absorption (insulin is variably absorbed from lipohypertrophic tissue) leading to unpredictable glucose levels. Patients must be educated about systematic injection site rotation (dividing each area into quadrants and moving within each quadrant). Injection into lipohypertrophic areas should cease – the tissue will remodel over months. When switching to a non-lipohypertrophic site, insulin doses may need to be REDUCED (by up to 20%) as absorption will be more efficient. Regular injection site inspection should be part of diabetes review.

Reference: ADS – 2024 – Insulin Injection Technique; eTG – 2025 – Endocrinology