Repeated injections at the same site can cause localized lipodystrophy, which is what has apparently occurred here. Localized lipodystrophy is associated with fibrosis and fat nodules just under the skin. A straightforward way to avoid localized lipodystrophy is to vary the location of injections. The nurse can begin by finding a different site for insulin administration, and continuing to find new site (at least 1 to 2 inches away from previous injection) each time. This finding does not require report to the physician, nor is it caused by an allergy to insulin. Lastly, oral insulin is not an option.