insulin-detemir 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

Lipoatrophy is a rare cutaneous side-effect that can develop at the site of insulin injection. Since the introduction of human recombinant insulin the number of cases has decreased although cases have been reported in association with the use of rapid acting insulin analogues and continuous subcutaneous insulin infusion (CSII), recently one case has been reported with the use of insulin glargine. Insulin-induced lipoatrophy is a subcutaneous fat atrophy at the sites of injection which is relevant not only because of the cosmetic problem, but also because of the variability of absorption it causes in the site of injection. This report describes a patient with a type 1 diabetes mellitus who develops a lipoatrophy induced by insulin detemir. To our understanding this is one of the first reported cases of lipoatrophy induced by insulin detemir.

Topics: Adipose Tissue; Adult; Atrophy; Diabetes Mellitus, Type 1; Female; Humans; Hypoglycemic Agents; Injections, Subcutaneous; Insulin; Insulin Detemir; Insulin, Long-Acting; Lipodystrophy