Lipodystrophy from Humalog & Levemir Injections

by Linda
(New Bern, N.C., U.S.A.)



Question: I was diagnosed with type 2 diabetes a year ago. I am a 63-year-old female.


After 10 months of Humalog and Levemir use, the skin around the injection sites is sunken and the fat has disappeared.


My doctors say this is very rare and likely permanent, and that I should consult a plastic surgeon.


Is there a way to reverse and, more importantly, prevent lipodystrophy at injection sites? Would an insulin pump be a solution, or would lipodystrophy occur at that site too?


Additional information: My glucose was 788 mg/dL when I was diagnosed, and I required two days in intensive care. I was prescribed Humalog Mix 75/25, additional Humalog when needed, Levemir at night and Byetta. A later doctor tried to reduce the number of injections using Victoza, glimepiride, Humalog when needed and Levemir.


Quick Answer



Sunken injection sites suggest lipoatrophy—localized loss of fat—not the more common raised fatty lumps called lipohypertrophy. Lipoatrophy is uncommon with modern insulin, but prevention is possible: stop using affected areas, rotate every injection systematically, use a new needle each time and have a diabetes professional inspect your technique and sites.


A pump is not a guaranteed solution because lipoatrophy can also develop around infusion sites. However, a pump may still be considered after an endocrinology review, with careful site rotation and regular infusion-set changes. Existing dents may remain, partly improve or occasionally resolve over months; plastic surgery is not automatically the only option.




What Should You Do Now?



  • Do not inject into any sunken, thickened, lumpy, tender, scarred or damaged area. Insulin absorption may be unpredictable there.

  • Ask an endocrinologist or diabetes nurse to examine every injection site and confirm whether this is lipoatrophy, lipohypertrophy, scarring, localized amyloidosis or another skin condition.

  • Request a hands-on review of needle length, injection depth, pen technique and your rotation plan.

  • Use a new needle for every injection and place each injection at least about 1 cm from the previous point within an organized grid.

  • Do not change Humalog, Levemir or any dose by yourself. Moving suddenly from an abnormal site to healthy tissue can change insulin absorption and may cause hypoglycemia, so glucose may need closer monitoring during the transition.



Can Lipoatrophy Be Reversed?


There is no guaranteed cream or home treatment. Some areas remain indented, but published cases show that lipoatrophy may stabilize or improve after the affected site is avoided and the insulin, injection method or pump cannula is changed under specialist supervision. Complete improvement has occasionally taken many months.


Because evidence is based mainly on case reports, treatment should be individualized. An endocrinologist may involve a dermatologist. Ultrasound or biopsy is sometimes used when the diagnosis is uncertain. Specialist treatments such as topical or injected corticosteroids have been reported, but they are not routine self-care and may affect glucose. Cosmetic fillers or fat grafting may be discussed only after the process has stopped progressing.



Would an Insulin Pump Prevent It?


Not necessarily. Pumps continuously deliver rapid-acting insulin through one cannula, so they can also cause local tissue changes. Pump users must rotate insertion sites and change the infusion set according to the device instructions—commonly every two to three days.


A pump may still reduce the number of daily needle punctures and improve diabetes management for an appropriate patient. If lipoatrophy occurs with a pump, specialists may consider changing the insertion area, cannula material or insulin analogue. The decision should be based on glucose needs, hypoglycemia risk, ability to manage the device, insurance and personal preference—not on the assumption that a pump eliminates lipodystrophy.



Was Insulin Appropriate for Type 2 Diabetes?


Yes. Insulin is commonly used in type 2 diabetes when glucose is extremely high, symptoms are severe, ketosis or a hyperglycemic crisis is possible, or tablets alone are not enough. A glucose level of 788 mg/dL with intensive-care treatment is a strong reason for immediate insulin therapy. Starting insulin was not evidence of inappropriate care or personal failure.


Some people with type 2 diabetes can later reduce the number of injections after glucose improves or other medicines are introduced, but this must be supervised. Do not try to eliminate insulin through diet alone. Glimepiride, insulin and GLP-1 medicines can also change hypoglycemia risk, so the full regimen needs coordinated review.




Contact the diabetes team promptly if:

  • new dents continue appearing despite site rotation;

  • the skin is red, hot, painful, draining or ulcerated;

  • glucose becomes unexpectedly high or low after changing sites;

  • you are unsure how to rotate injection or pump-infusion areas.




Related Questions




Related Resources




References



  1. American Diabetes Association. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2026.

  2. DailyMed. Humalog (insulin lispro) prescribing information.

  3. DailyMed. Levemir (insulin detemir) prescribing information.

  4. Kanagaretnam H, et al. Insulin Pump-Induced Lipoatrophy: Proposed Diagnostic and Management Algorithm. JCEM Case Reports. 2025.



Answered by: Dr. Albana Greca Sejdini, MD, MMedSc

Medically reviewed by: Dr. Ruden Cakoni, MD, Endocrinologist

Last reviewed: July 2026


Medical disclaimer: Educational only—not personal medical advice. Diagnosis and treatment should come from a qualified clinician who knows the patient’s medical history.


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