What is Lipohypertrophy?

This is the deposition of fats in the subcutaneous area, usually found at the injection sites of insulin in diabetes mellitus patients. In diabetes mellitus injection sites such as abdominal area surrounding the umbilicus, upper and outer part of the thighs and upper arm and buttocks, these areas contain subcutaneous fats. Subcutaneous layer of the skin, also known as the hypodermis and the superficial fascia, is the usual site for insulin injection because that this area causes less bleeding during the process. In subcutaneous tissue, considered being the best site for insulin injection, the absorption of the insulin is slow progressing thus the patient control of blood sugar is well managed.

Lipohypertrophy particularly affects the adipose tissues in subcutaneous layers. It is in the subcutaneous skin layer where you can find the adipose depots. The formed lumps of adipose tissues and scar tissues collectively called as lipohypertrophy or fatty lump are firmer lumps as compared to other subcutaneous cells. This is a frequent, chronic yet not very serious skin complication seen in diabetes mellitus especially across the area or site with repeated insulin injections. This is the reason insulin injection site rotation is recommended to diabetics.

Fatty lumps (lipohypertrophy) either side of umbilicus

Image source: drbriffa.com

Fatty lumps at legs

Image source: accessmedicine.net

Symptoms

Although most of the time lipohypertrophy or fatty lump is edema-free and pain free, there are also some subtypes of lipohypertrophy that are considered painful ones.

• The most common sign and symptom is a soft lump is felt and seen in areas of repeated injection. Although fatty lumps are seen more frequently in Type 1 diabetes, this can also occur in Type 2 DM.
• There is presence of disproportionate swelling of legs in relation to trunk.
• Fatty lumps are not painful or tender to touch.
• In orthostatism, there is no edema formation.
• Period of hyperglycemia in patients with lipohypertrophied tissues commonly occurs thus leading to unstable DM.

Causes

The disorder of fatty distribution in diabetes mellitus clients are basically because of repeated insulin injection in same spots or the injection sites are too close together. Some children may prick the skin during insulin injection in order not to feel the pain of injection thus not leaving enough space in between injection sites. Although one of the reasons why these clients may be doing the injection on the same areas may be due to the fact that they can’t reach other suitable areas for insulin injection or mainly because of dexterity.

If the needle is not changed frequently and becomes blunt, the injection becomes painful and causes more damage to the integrity of the skin contributing more to the development of lipohypertrophy. When fatty lumps develop more complications may be associated with diabetes mellitus.

In the event that there are already fatty lumps formed then insulin absorption is affected. The insulin plays important role in maintaining the energy level of a person. It is needed in order for the simple sugar be converted to energy. But the presence of lipohypertrophied tissues in insulin injection spots delays the absorption of insulin since these lumps have fewer blood vessels. When this happens the body becomes insulin resistant and can’t convert the sugar into energy. The sugars remain in the bloodstream and eventually are being stored as fats in liver, abdominal area and other parts of the body. There can be increased in abdominal girth due to central fat accumulation in central lipohypertrophy. Buffalo hump or a dorsocervical fat pad and increased breast size in men called gynecomastia.

Furthermore, lipohypertrophy can also occur in person with HIV (Human Immunodeficiency). The protease inhibitors in the meds taken by HIV clients affect the fatty lump formation. HIV protease inhibitors are effective antiretroviral agents. Prolong used of protease inhibitors in the treatment of HIV lead to the development of lipohyperdystrophy that is a metabolic complication in the alteration of fat metabolism. Lipohypertrophy in HIV clients lead to truncal obesity and also affects the insulin leading to complication of diabetes in HIV clients.

Treatment

The primary treatment for lipohypertrophy is to leave it alone for weeks or month. Sometimes it may take a year before the fatty lumps disappear and some cases fat suctioning procedure has been used as a treatment. Another way to get rid of these fatty lumps is proper diet and exercise which are considered the primary important remedies. Increased intake of soluble and insoluble fiber may lessen the development of lipohypertrophy, and so does resistance exercise increase the chance of recovery.

For diabetics who have lipohypertrophy, in order to treat the fatty lumps one must do this is by having an insulin injection rotation scheme, in which the injection sites are rotated in days in a week. Injection in the site with fatty lumps must be avoided since the insulin absorption is decreased on this site. But once you inject insulin in fresher site with no lipohypertrophied tissues lower the insulin concentration by 25% when using rapid acting insulin. Remember that this site will absorb the insulin faster than the previous site with fatty lumps, lowering the dose thus avoiding another complication of DM that is hypoglycaemia.

Here is an useful resource on where to inject the insulin injection

Smiling is one of the most effective ways to attract someone’s attention. However, when teeth are discolored, it is often embarrassing to show them or smile with the teeth exposed.

The color of the enamel of the teeth is naturally off-white or light yellowish in color. During childhood, the normal color of the teeth is generally whiter than in adults. This is because as people grow old, the teeth are exposed to chemicals that discolor the teeth such as food, bacteria, smoking and certain medications. But because of wanting to have perfect smile, teeth whitening has become popular. Teeth whitening have become one of the fads because it increases the attractiveness of a person’s smile. Teeth whitening can be accomplished in dental clinics, but may also be done at home. Here are the tips to help you whiten your teeth:

1. Go for teeth bleaching

Bleaching of the teeth by dentists is the most effective way to whiten the teeth. It is a procedure done in cosmetic dentistry to improve the color of the tooth enamel. Bleaching not only restores the natural white color, but whitens the teeth beyond it. Bleaching may involve the use bleaching strips, bleaching gel, bleaching pen, brushing, laser bleaching or natural bleaching. However, certain stains on the teeth are not responsive to bleaching such as stains brought about by tetracycline and iron preparations. These require more extensive whitening and bleaching techniques. Most of the bleaching techniques done nowadays may produce whitening effects in as fast as 30 minutes to 1 hour in just a single dental visit. Some bleaching techniques also use ultraviolet lights that may destroy the eyes.

2. Use tooth whitening commercial products

Teeth whitening toothpastes, chewing gums, gels and mouth rinses are available over the counter or in department stores. These products usually contain chemicals such as carbamide peroxide, which helps in whitening the teeth

3. Natural teeth whiteners

Natural teeth whiteners are also available to whiten the teeth at home. Most of these substances react with water to form peroxide. Peroxide is the one used for whitening the teeth at home and dental clinics. There are various ways to whiten the teeth naturally, which include:

Strawberry

Strawberry contains malic acid. Malic acid is one of the most common whitening agents of the teeth. This can be found in strawberries. Strawberries can be mixed with baking soda and applied on the teeth to remove teeth discoloration from certain foods and beverages. Do these by crushing the strawberries until becomes a pulp and mix with baking soda. Apply the mixture using a soft-bristled toothbrush into the teeth. Leave the mixture for 5 minutes then brush thoroughly with toothpaste and rinse with water. Then, use floss to remove strawberry seeds that may have gotten in between the teeth. Do this procedure once a week.

Baking soda

Baking soda is one of the conventional ways of whitening the teeth at home. This involves brushing the teeth gently with baking soda and leaving it for 5 minutes. Baking soda is an abrasive teeth whitener, which removes the discolorations on the surface of the enamel. The use of baking soda should be monitored because this may damage the enamel when used several times a week. Dentists suggest using baking soda at most twice a week.

Other fruits and vegetables

Apples, carrots and celery also help the teeth to become whiter. These foods stimulate the production of saliva, which is a natural teeth cleanser. Fruits also maintain fresh breath by killing bacteria in the mouth that produces unpleasant odors. Apples also contain malic acid that helps in bleaching the teeth. Crush the green apples and apply the paste in the teeth for 5 to 10 minutes and rinse off.

Lemon

Squeeze the juice from lemon and apply it on the surface of the teeth. You can also use brush to spread the juice. Lemon should be rinsed with lukewarm water to remove the acid because the high acidity of lemon juice may damage the enamel.

Hydrogen peroxide mouth rinse

Hydrogen peroxide is the main component of teeth whitening products such as pastes, toothpastes and gel. Hydrogen peroxide should be diluted in water and used as a mouth rinse. Be careful not to swallow the solution because this may lead to poisoning.

Everyone can have whiter teeth with the help of teeth whitening solutions. Celebrities are not the only ones who can afford teeth whitening treatments, but also normal individuals as well with the help of the natural teeth whiteners.