It’s What’s Inside That Counts…

No, this isn’t a post about inner beauty and about how everyone is beautiful! I’ll save THAT conversation for another day, as I do have some definitive thoughts on it. But if you’ve had Diabetes for the amount of time I have, you’ve been through some shit. And you’ve put up with some shit. Diabetes is shit… That’s the takeaway! But in all seriousness, the topic of today’s post are physical scars, which are mostly inside. And having Diabetes or using the associated therapies can leave a number of different scars.

Let’s begin with the digits, shall we? The fingertips… Part of effectively treating Diabetes is the frequent testing of one’s blood sugar levels. Although I was limited to testing only once a day when I was first diagnosed, as a result of financial constraints and my parents being unfortunate enough not to know better, the ideal situation is to test at LEAST five times a day or more. This would include when waking, before every meal and before hitting the sack at the end of the day.

As I got older and took control of my treatment, I started to test my blood sugar more and more in order to avoid many of the complications I had as a child. The result of this is that my fingertips lost sensitivity and accumulated hard, shell-like scarring. This type of scarring is true scarring, same as you’d get from an injury or a wound. It happens due to the accumulation of a fibrous protein called collagen, and is the body’s way of helping to heal the wound. Although the scar tissue may soften over time, it never truly goes away. Even if I have feeling in my fingertips nowadays, you can still see the scar tissue if you look closely (especially since I still do finger pokes.)

The more problematic scarring (because let’s be honest: as long as the needle pokes through the tissue and draws blood, fingertip scarring is no kind of a big deal), is Lypohypertrophy. You can check that term out on Google or Wikipedia if you wish, but the gist of it is a visible lump under the skin near your insulin injection sites. Besides being painful, it can also affect how your insulin is absorbed and the length of its effectiveness. I’m just going to refer to them as “Lumps” for the rest of this post…

People forget that insulin is a growth hormone and because of that fact, the Lumps you find at your injection sites are often an accumulation and/or growth of fat tissue. This is generally caused by using the same injection site repeatedly, but does go away over time. Depending on the severity of the Lumps, it can take several days, weeks, even years in some cases for them to completely heal and disappear. But they generally do, over time.

Here are a few ways to avoid developing Lypohypertrophy:

  1. Rotate your injection sites: This is something you should be doing anyway, but you want to avoid using the same spot over and over without allowing it some time to heal. In fact, my pump trainer was telling me about a Type-1 who only uses one side of his abdomen per month, allowing for a full calendar month for the other side to “heal” and for Lumps to disappear. I don’t go to THAT extreme, but I do switch sides with every new infusion set;
  2. Use a fresh needle: I used to be EXTREMELY guilty of this one. Either from laziness or trying to be cost-saving, re-using the same needle over and over can be terrible for you flesh (see illustration below). Even after one use, the point of a needle begins to warp and change shape, requiring more pressure to breach your flesh and causing more damage on the way in. This can lead to actual scarring as opposed to just Lumps. It will also increase the chances of inflammation and infection;
  3. Leave some space: If you are injecting on the same side and are close to the previous injection site, make sure you leave at least an inch of space between your current site and the new one. Like I said, insulin is a growth hormone. If you inject too close to the previous site, absorption and effectiveness can still be an issue;
  4. Give yourself time to heal: Alright, this one may be riding on the coattails of #1, but it’s important. Like anything else, injection sites need time to heal and get better. No matter what you may read online (this blog included), your body is unique and your healing time will be yours alone. So make sure you’re giving it the time it needs before poking into your preferred injection area.
Microscopic view of a needle tip after repeated use

Obviously, if things seem kind of wonky with a previous injection site, such as discolouration, throbbing or pain or the tissue is hot to the touch, you should seek medical attention as it could be an indication of a worse injury or even infection. I’ve just complicated matters for myself, since CGM requires a second injection site and is supposed to last for seven days. So I get to yo-yo two different injection sites with different change times and try to prevent reusing those sites too frequently.

At the end of the day (or week), those Lumps will disappear as long as you stay true to fresh needles and fresh injection sites. You may develop Lypohypertrophy on occasion even IF you do all these things, so don’t be surprised if you get the occasional Lump. Just be sure to take care of them properly and you’re good to go! ☯

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I am a practitioner of the martial arts and student of the Buddhist faith. I have been a Type 1 Diabetic since I was 4 years old and have been fighting the uphill battle it includes ever since. I enjoy fitness and health and looking for new ways to improve both, as well as examining the many questions of life. Although I have no formal medical training, I have amassed a wealth of knowledge regarding health, Diabetes, martial arts as well as Buddhism and philosophy. My goal is to share this information with the world, and perhaps provide some sarcastic humour along the way. Welcome!

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