I had several highs in the 140-200 range before I started pumping. I did not know the reason for that. My pumping started in June, 2007, and I still had highs while placing my sites on my upper abdomen. I thought my pump was defective and called the Minimed hotline. They asked if I rotated my sites. I did not what they were talking about. At no time during my first 62 years of injections did I hear about site rotation. I then realized I had scar tissue and it was a very young lady from Minimed who told me about it. I began using other body parts and the highs stopped. That was wonderful! I rotated between my lower ab and upper legs and had very good control. Every few months I tried my upper ab again, but the absorption was still poor, and the highs would return. I stopped experimenting with my upper ab in late 2008, and assumed the scar tissue was permanent.
Nine days ago I placed an infusion set about 1.5 inches above the level of my navel. I had good absorption. I thought it might be a coincidence? I have now placed four infusion sets on my upper ab and all of them have worked perfectly. It seems that the 4 year wait has caused my scar tissue to heal itself. I will admit that I have not yet tried to use levels more than 1.5 inches above my navel, but I think higher levels will also be good. The area I am using now had a lot of scar tissue s recently as late 2008. I was beginning to have slower absorption on my lower ab and upper legs. Perhaps there was some scar tissue slowly developing there. If my upper ab has healed I will have a lot of new territory to use, and that will help my lower ab and upper legs get more time to heal.
I thought other people here who have scar tissue might like to hear this. Both MDI and pump users may experience scar tissue and poor absorption unless site rotation is used consistently.
Well, scar tissue is when collagen cross links to repair a wound. It essentially replaces the tissue that normally would be there with this cross link matrix. Over time, as cells die and are replaced the scars can heal. This process will typically take place over months and years and will vary. I still have some scars from my childhood that have never completely disappeared. It is reasonable to think that a 4 year break would have been enough improvement to heal you abs and enable including them back into the rotation. But you should be cautious, insertion sites cause scaring at a much higher rate than injections.
It takes between 3-6 months for my scar tissue to heal. I have a few hard spots in my upper thighs because I use those the most for injection sites. They are very painful if you hit it with an injection again and tend to bleed. Also have very poor absorption like you’re pointing out.
If you regard “several highs in the 140-200 range” due to scar tissue over the decades you’ve had diabetes… Wow, you must have such good control overall!
I’m not really sure I feel I can comment here because I hit the 140-200 range a lot more frequently than several times a decade.
I’m surprised that back in the 70’s/80’s they didn’t tell you about site rotation. That was a very standard part of my checkups in that era, as well as rigorous checks for Lipohypertrophy. In the past 10 or 20 years this doesn’t seem as big of a concern in my docs. Maybe they just assume (don’t know if it’s true or not) that the shift from animal to human insulin makes it less of an issue (again I don’t know if that’s true or not but I suspect that’s the reason why I don’t hear it emphasized so much.)
I wonder if when you say “scar tissue” you mean what the docs mean when they look for “lipohypertrophy” or if it’s something different.
Tim, I did not feel lumps under my skin, but the absorption was poor sometimes, nonexistent at other times, but ok sometimes too, depending where I injected on my upper ab. Then with infusion sets I was getting the "No Delivery " alarm on my MM 522. This was not happening on my lower ab or legs, because I had not used them so much.
I was always told to rotate my sites back in the 60’s and 70’s and when I switched from animal to human insulins I was told to be careful because there would not be so much scar tissue and the absorption rate would be quicker. With the animal insulin I had developed huge lumps, hard lumps under the skin on my legs, I remember the doctor telling me not to “rub” the skin after a shot because it would increase the absorption rate.
Back in those days, without the ability to check your BG we had to simply rely on what the doctors believed.
Sheila
Wow,Sheila. I had not heard that we should not rub the areas. Now, I hear that massaging can help with the scar tissue, because we want to increase the absorption to prevent high blood sugar.
After some period of time I do not care HOW much we rotate… you will encounter spots you DO and have used before. After years, decades, quarter centuries (or longer) it IS going to happen.
I have avoided like the plague many spots and locations for at minimum a decade or longer, yet have had ZERO change to them (: ( .I rotated ZEALOUSLY since I was a kid. Apparently it does not matter much…
What precisely is scar tissue exactly anyway?!?!?!
Is our scar tissue the same as a scar from surgery, or an old injury I wonder? Massage anything and the tissues will increase the blood flow to/away from that area. My question is… can OUR scar tissue be broken up in the manner surgical scar tissue, normal muscular adheasions might be???
Asked a bunch of doctors, none knew that answer >: Z .
None of my scar tissue from injections appeared on the skin surface. It is all beneath the surface, and I don’t think it is very deep. I think you can learn more by using Google than trying to get answers here.
Actually, massage may help with scar tissue. Ultrasonic massage is used in physical therapy to break up scarring and increase circulation as part of the process. Those same ultrasonic massagers are now available for home use. I’ve not heard about their use for these scars, but it is entirely plausible.
The reason you are told not to massage after injection is that it alters the distribution of the injected insulin pocket and increases circulation causing variability in the rate of insulin infusion into your body. Life is already full of variables, who needs more.
Actually, what you have is lipoatrophy. Apparently this condition has become much rarer with the advent of the newer recombinant human insulins. You might want to check out the glucosteroid treatment in the article.
More typically, repeated use of a site will cause lipohypertrophy, the growth of fat deposits. The constant high levels of insulin at the site cause the fat surrounding the site to preferentially take up fat. This can cause a fat lump. Fortunately, rotating sites cures the cause and the fat deposit usually just disappears over time. Again, lipohypertrophy was more prevalent with earlier insulins.
While the docs back in the animal insulin days always talked about and looked for Lipohypertrophy, what they actually found on me was the lipoatrophy in my most used injection sites.
There’s a broad assumption that these issues are greatly lessened by human insulin compared to the old days of animal insulin, but I don’t know of any statistics or papers that show it. It’s just assumed. Maybe it is common sense and we don’t need such studies. In any event, even getting ahold of beef-pork insulin today for humans (as opposed to say Vetsulin) is difficult. And my docs never emphasize site rotation anymore like they did in the old days - I was grilled on site rotation in EVERY endo visit back then.
Of course while they said they found lipoatrophy at my favorite injection sites and today they also say my fingertips are entirely scar tissue, I look at my injection sites and my fingertips and they look like, well, me. I don’t see anything unusual. As far as I can remember I always looked that way
Whoops, looks like I was flying off the handle in assuming that no medical studies look for lipohypertrophy or lipoatrophy in the case of the human or human analog insulins.
A very easy google search for “insulin” with “lipoatrophy” turned up a lot of recent medical journal hits associated with human insulin:
Lipoatrophy Associated With Lispro Insulin in Insulin Pump Therapy
by ME Griffin - 2001 - Cited by 24 - Related articles
Hirsch JB, D’Alessio D, Eng L, Davis C, Lernmark A, Chait A: Severe insulin resistance in a patient with type 1 diabetes and stiff-man syndrome treated with … care.diabetesjournals.org/content/24/1/174.full - Similar
A Case of Lipoatrophy With Insulin Glargine — Diabetes Care
by FJ Ampudia-Blasco - 2005 - Cited by 15 - Related articles
Griffin ME, Feder A, Tamborlane WV: Lipoatrophy associated with lispro in … care.diabetesjournals.org/content/28/12/2983.1.full - Similar
Human Insulin–Induced Lipoatrophy — Diabetes Care
by AJS Ramos - 2006 - Cited by 6 - Related articles
We report a case of localized lipoatrophy in a patient treated with human … care.diabetesjournals.org/content/29/4/926.full - Similar
Show more results from diabetesjournals.org
Lipoatrophy can happen with any subcutaneous insulin
by FH Saleh - 2006
Nov 6, 2006 … Atlan-Gepner C. Insulin-induced lipoatrophy in type I diabetes: a. Diabetes Care 1996 19 1283–1285 [Abstract]. … www.endocrine-abstracts.org/ea/0012/ea0012p40.htm - Cached - Similar
What conclusions did they reach I wonder? Regardless of which specific/particular flavor it might be CURE of it is a VERY different creature than simply “…avoiding the area for a while…” and hoping it goes back to normal.
Having avoided them all for a real long time… it has failed to provide results. Seeking a more effective approach…
Stuart
