insulin--isophane and Lipodystrophy

Lipoatrophy is a rare complication of treatment with insulin analogues. It has been reported with insulin Lispro (Eli Lilly, Indianapolis, Indiana, USA) and insulin Glargine (Sanofi-Aventis, Paris, France). To our knowledge, this is one of the first reports of lipoatrophy with Aspart, biphasic Aspart and Detemir insulin analogues (Novo Nordisk, Bagsvaerd, Denmark). We report the cases of four children with type I diabetes who were commenced on NovoMix 30 or NovoRapid/Levemir insulin injections. They developed lipoatrophy at the injection sites after 2-3 years of treatment. In two of our patients, lipoatrophy resolved when the injection sites were changed, suggesting that local factors could be the cause of lipoatrophy. However, lipoatrophy developed at the new sites in the other two patients, requiring a change of insulin preparation. Regular examination of the injection sites facilitated early detection of lipoatrophy in our patients. Lipoatrophy completely resolved over 1-2 years in all patients with no recurrence after 3-4 years of follow-up.

Topics: Adolescent; Biphasic Insulins; Child; Child, Preschool; Diabetes Mellitus, Lipoatrophic; Diabetes Mellitus, Type 1; Humans; Hypoglycemic Agents; Insulin; Insulin Aspart; Insulin Detemir; Insulin, Isophane; Insulin, Long-Acting; Lipodystrophy

A case of a 32-year-old woman with type 1 diabetes diagnosed 1.5 year before presention. The patient was referred to the diabetology department due to decompensation of diabetes and excessive hypodermic atrophy of both thighs. Early symptoms of lipoatrophy appeared after 1.5-2 months of insulin glargine use, in spite of frequently changed hypodermic needles and injection sites on both thighs. Simultaneously, deterioration of diabetes compensation was observed (hyperglycaemia between meals and in the morning), which was corrected by the patient with extra injections of a short acting analogue. Additional examinations confirmed type 1 diabetes (C-peptide <0.01 ng/ml) with concomitant hypothyroidism in the course oh Hashimoto disease. After change of insulin (Insulatard twice daily, Novo Rapid with meals) and injection site (administration to hypodermic tissues of arms and abdomen was started), diabetes compensation was achieved. At follow-up visit after 12 months, diabetes was still under control - HbA1c 6.8%. Moreover, progress of lipoatrophy is not observed.

Topics: Adult; Diabetes Mellitus, Type 1; Hashimoto Disease; Humans; Hypoglycemic Agents; Hypothyroidism; Insulin; Insulin Aspart; Insulin Glargine; Insulin, Isophane; Insulin, Long-Acting; Insulin, Regular, Human; Isophane Insulin, Human; Lipodystrophy; Male

Topics: Abdominal Wall; Adipose Tissue; Aged; Diabetes Mellitus, Type 2; Female; Follow-Up Studies; Humans; Injections, Subcutaneous; Insulin, Isophane; Lipodystrophy

Topics: Child; Diabetes Mellitus, Type 1; Humans; Hypoglycemic Agents; Insulin; Insulin Lispro; Insulin, Isophane; Lipodystrophy; Male

Topics: Adult; Animals; Cattle; Crystallization; Diabetes Mellitus; Drug Contamination; Evaluation Studies as Topic; Humans; Insulin Antibodies; Insulin, Isophane; Insulin, Long-Acting; Lipodystrophy; Proinsulin; Protein Binding; Skin Manifestations; Swine