OBJECTIVES: Lipohypertrophy (LH) is a major complication of insulin therapy causing unpredictable insulin absorption and cosmetic concern to patients. The present study was aimed to assess the frequency of lipohypertrophy at injection sites and its relation with injection practice among Type 1 Diabetes (T1D) patients attending a tertiary care hospital in Northern India. METHODS: Cross-sectional questionnaire on demography, insulin injection practices and anomalies at injection sites, was administered to 31 T1D patients and/or their caregiver. Patients using syringe and/or pen since 3 months were enrolled in the study. RESULTS: The mean age of patients (n=31) was 16.89±6.4 years; the average duration of diabetes 63.8 months and mean HbA1c (n=28) of 10.21±2.89%. The daily frequency of injection was four in 23 patients, followed by three in 4, two in 3, and one in 1 patient. Lipohypertrophy was observed in 10 patients whereas lipoatrophy in 1 patient (32.3% vs.3.2%). 9 patients had lipodystrophic lesions in abdomen as it was the preferred site of injection by 27 patients. All patients admitted injecting into lipodystrophic areas. Interestingly, the odds of having LH in the presence of rotation routine is 1/6^th than that of the absence of rotation (OR 0.167, 95% CI-.029-.95), and was statistically significant (p 0.048, one-sided Fischer-exact test). Only 19 patients utilised available area fully. Although statistically insignificant (p>0.05), LH seemed to be more frequent in patients using smaller injecting areas than the larger ones (50% vs.27%). A statistically significant association was not found between LH and needle reuse. However, mean use of needle was higher in the LH group than the non-LH group (12.7 times vs 8.5 times). CONCLUSIONS: Despite the well-established evidences supporting use of rotation routine, large injection areas and avoidance of needle reuse for the prevention of LH, the results of the present study confirms that these practices need to be readdressed.