Treatment that does work!

The treatment that did work, consists of two basic parts

1) FIXING PAST DAMAGE: Carefully filling up depressed skin areas with injections of apidra insulin and 4mm needles (3-8 units before every meal).

2) FUTURE DAMAGE CONTROL: Apidra insulin in my pump, changing canula every two days, using Sure-T's instead of Silhouettes, use Cavilon spray for skin protection.

After that, it was a matter of time (be patient, it's been 7 months since I'm doing this, no more new skin depressions, and the old one is filling up slowly). I hated it at the start, using injections and an insulin pump seemed like the worst case scenario. However, it's only temporary, and you get used to it.

My hypothesis on how lipodystrophy, or lipoatrophy, is caused in case of CSII, is that skin just doesn't like to be hurt by needles, infusions sets, adhesives, and insulin (solvents!) for years and years on end. At some point, skin is likely to protest. This may be an allergic reaction, or scarring, or what not. If you want to prevent this from happening in other places, you have to be very careful in placing your infusion sets. Not that you're very sloppy, and that other people with diabetes who do not develop skin problems are much more careful and clean etc. If you've started to develop depressions in your skin, it just means you have a sensitive skin. You may not always have had such sensitive skin, or shown these reactions, but this can come up at any moment, and from then, you'll have to learn to deal with it.

So, the main message for prevention is: be very very nice and careful with your skin! Use a different infusion set (I changed from 13 mm Silhouette to 6 mm Sure-T's), change the set more often (I went from every 3 days to every 2 days), use something for skin protection (apply Cavilon), and apply something to the skin after removing infusion sets (Bepanthen for example).

The main message for getting rid of the lipodystrophy (or lipoatrophy) places that already exist: insulin is a great filler! Where it is injected, fat cells are likely to develop. This will help you to fill up the holes. Use small needles (4mm!) to inject small amounts (3-8 units) of insulin (with as little solvent as possible,  for example Apidra by Sanofi-Aventis). Cosmetic surgery may not be necessary, and maybe you'll be able to put infusion sets at the affected area's again, after a year (I hope so. Haven't tried it yet, I'll post my experiences on this blog when I have.)

Check out the 'Treatment results" post to see a report on the results.