Bruises and swellings on the stomach (or more accu- rately the abdominal
wall) due to insulin are caused by two distinct mechanisms
and are not usually variations
of the same thing. However, occasionally a bruise will be severe enough
so as to cause an
actual swelling.
Bruising is due to leakage
of blood from small vessels
penetrated at the time of the insulin injection.
Some people are more likely to bruise than others, including the elderly and those
on anticoagulant or antiplatelet medications (blood thinners) such as warfarin,
heparin, clopidogrel, ticlopidine, and others. Some people on routine doses of aspirin for protection
from stroke and heart attack will note an increased tendency to bruise with their insulin injections, while others do not.
Injection tools or technique may also play a role. Those
with relatively small amounts of body
fat on their abdominal
walls (or thighs or arms if you use them) need to be sure to lift and gently pinch the skin and insert the needle at an angle in the middle of the pinched tissue. Injecting
the needle directly and to the hilt may lead to an inadvertent injection into the mus-
cle.
This will change
the pattern
of
action
of
the insulin
and lead to a bruise or sometimes a painful bleed into the muscle itself. Some types of needle are more prone to cause bruising in some individuals than others. If you bruise easily, use the smallest diameter
(gauge) of needle you can find. Remember
that the higher number of gauge means a smaller diameter. Swellings,
especially if they are chronic, are often due
to a
property of the insulin
itself. Insulin is one of the hormones responsible for growth and maintenance of our tissues including muscle protein
and fat stores. If insulin
is injected repeatedly in
the same area, addi- tional fat
can become laid down in that spot.
This takes on the appearance of a painless fatty mound (lipohypertrophy), which can be somewhat disfigur-
ing. Fortunately, these fatty mounds will disperse if the insulin
is no longer
injected there, although
it
may
take several weeks
or months to remodel. To avoid these, the insulin injection sites
should
be
rotated.
Keeping a simple map of
your abdominal wall, divided
into a grid of 20 or 30 boxes and checking off a box after you have used it, will allow you to avoid using the same spot repeatedly within a 3- or 4-week period. Rarely, the opposite
of lipohypertrophy may occur, i.e., loss of body
fat in a localized or more generalized way. This is known as lipoatrophy. This is sometimes pre- ceded by
a viral infection, but more often the underly- ing cause cannot be identified.
Red or itchy areas at the site of injection
may indicate an allergic reaction to the insulin or a component of it. This is quite rare with modern insulins,
but will neces- sitate a process known as desensitization, which needs to be performed under the supervision of a specialist. Larger red or discharging swellings,
which are shiny and tender, indicate an abscess
due to infection and you should seek medical attention
promptly.
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