Diabetes

Lead Researcher: Dr Lala Leelarathana

Supported by the Metabolic & Endocrine Theme

Lipohypertrophy (commonly known as Lipos) is a well-known skin complication of insulin therapy affecting around 50% of people treated with insulin injections or insulin pump therapy. Lipos are due to the build-up of fatty tissue underneath the injection sites. Lipos can stop the insulin from working properly, leading to erratic glucose levels with both “highs” and “lows”. Although there has been a lot of progress in diabetes technology in the last decade, little progress has been made on the impact of Lipos on glucose control.

Traditionally, Lipos are detected by clinical examination. However, clinical examination alone can miss Lipos, and more recent studies using ultrasound scanning show much higher rates of Lipos in insulin-treated people.  A recent study from China has shown improved glucose levels in people after avoiding Lipos, but that study did not look at detailed glucose information available on continuous glucose monitoring. No study has also looked at whether the usual diabetes clinic team could be trained to perform ultrasound scanning of injection sites to detect Lipos when people attend routine diabetes clinics.

In the current study, we want to train two members of the usual diabetes team to perform ultrasound scanning of injection sites in people treated with insulin and high levels of glucose fluctuations. We will then create a “map” of good injection sites and sites affected by Lipos. We will advise study participants to avoid the sites affected by Lipos for the next six months. We want to see whether by avoiding Lipos, glucose control will improve using continuous glucose monitoring. We also want to perform a repeat scan six months later to see whether these Lipos will improve when injections to these sites are avoided. If this study shows positive results, performing an ultrasound scanning of injection could become part of future diabetes care.