Atypical Abdominal Lump in a Patient with Diabetes.

A 41-year-old woman with poorly-controlled type 2 diabetes (A1c 10.7% [93 mmol/mol]) presented to the diabetes clinic for routine follow-up. She has had diabetes for 15 years and her A1c remained elevated despite reported adherence to increasing doses of human 70/30 insulin. On examination, she had a hyperpigmented induration on her left abdomen (Figure 1, black arrows), where she has been injecting insulin for many years. She reports discomfort and bruising at this area. She was instructed to stop injecting insulin at the presumed lipohypertrophied site.