By CLAIRE BATES
10 February 2012
A 55-year-old man with type 1 diabetes shocked his doctors, after he revealed what looked like two bottom cheeks hanging below his navel.
The patient from South Africa, had been told to inject his life-saving insulin jabs into two areas of his stomach to control his blood-sugar levels.
However, he hadn't realised that he needed to rotate the injection site around different parts of his body because the hormone insulin encourages the build up of soft fatty swellings within the layers of the skin.
Lipohypertrophy: The male patient had developed two fatty masses as a result of decades of injecting insulin into the same two sites
The man went on to develop 'firm and pendulous' masses on his stomach - a condition known as lipohypertrophy. Mild cases are surprisingly common, however this patient had a severe case as he hadn't changed his injection sites for three decades.
Dr Stan Landau, from the Centre for Diabetes and Endocrinology in Joannesburg, was part of the team who treated the patient.
He told Mail Online: 'We are a group of five senior doctors with many years experience between us and have never seen such a case before.
'We felt we needed to publish the picture in a journal because it was such an extreme case.'
Dr Landau said the patient had continued to inject himself in his stomach because he thought the lumps were normal in insulin users.
'He had seen others with similar, but smaller masses in the same location. Sadly the lumps, though painless, had never been inspected,' the expert said.
Daily jab: Insulin can be injected into the stomach, arms, bottom and thighs
Dr Landau added that although the lumps may shrink slightly the disfiguration would be permanent without plastic surgery.
The patient was encouraged to rotate the injection-site and use a smaller needle. He was also given a different type of insulin.
Unfortunately the team lost contact with the patient after he failed to return for follow-up appointments.
Writing in the New England Journal of Medicine, the team said the case highlighted the need for better medical advice for diabetes patients.
'Sadly many people with diabetes haven't received proper education in terms of how to give an insulin shot correctly,' Dr Landau said.
'It needn't be so.'
Type 1 diabetes develops when the insulin-producing cells in the body have been destroyed and the body is unable to produce any insulin. It usually appears in patients before the age of 40.
Insulin allows glucose to enter the cells where it is used as fuel. Without it the glucose builds up in the blood.
Diabetes affects approximately 2.8 million people in the UK. Type 1 accounts for one in 10 people with the condition and is treated with daily insulin injections along with a healthy diet and regular physical activity.
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