Over the last decade, there has been an increase in reported cases of lipoatrophy as a complication of treatment with analogue insulin preparations. Lipoatrophy causes undesirable cosmetic appearances and may cause variable glycaemic control. We report a case series of four female patients from a tertiary paediatric diabetes unit presenting with lipoatrophy while on treatment with insulin aspart via a continuous subcutaneous insulin infusion (CSII) pump for the management of type 1 diabetes. We did not observe any cases of lipoatrophy in patients receiving multiple daily insulin injections. In examining the effect of lipoatrophy on glycaemic control, we found no detrimental effect of lipoatrophy on the patients’ glycated haemoglobin. Cases of lipoatrophy should be reported to drug manufacturers and through the appropriate national adverse drug reaction reporting system. This will facilitate observation of trend, and help monitor for associations, informing future research.