Lipohypertrophy is a lump under the skin caused by accumulation of extra fat at the site of many subcutaneous injections of insulin. It may be unsightly, mildly painful, and may change the timing or completeness of insulin action. It is a common, minor, chronic complication of diabetes mellitus. Lipohypertrophy is a lump under the skin caused by accumulation of extra fat at the site of many subcutaneous injections of insulin. It may be unsightly, mildly painful, and may change the timing or completeness of insulin action. It is a common, minor, chronic complication of diabetes mellitus. Typical injection site hypertrophy is several inches or cm across, smoothly rounded, and somewhat firmer than ordinary subcutaneous fat. There may be some scar tissue as well, but the major component is adipose tissue, as insulin exerts a hypertrophic effect on adipose cells. To avoid lipohypertrophy, persons with diabetes mellitus who inject insulin daily for an extended period of time are advised to rotate their injections among several areas (usually upper, outer arms, outer thighs, abdomen below and around the umbilicus, and the upper parts of the buttocks). Rotation charts are often provided as part of diabetes education to help prevent lipohypertrophy.