insulin-glargine and Lipodystrophy

Any insulin formulation can in principle cause lipoatrophy; even cases associated with recombinant human insulin have been reported. An increasing number of case reports have been published indicating that lipoatrophy also develops after treatment with various insulin analogues.. In this review, we summarise the literature on lipoatrophy associated with the use of insulin analogues published to date. A new case of lipoatrophy associated with the use of glargine is presented.. Readers will gain insight into: i) pathogenesis of lipoatrophy associated with the use of insulin analogues and ii) clinical features of lipoatrophy.. Twelve cases with lipoatrophy under treatment with insulin analogues have been reported so far. The exclusive occurrence in lean type 1 diabetic patients, its overlap with further autoimmune diseases and the overrepresentation of female individuals point to an immune pathogenesis. The respective exposition to the analogues lispro, aspart, glargine and detemir prior to lipoatrophy development varied considerably between 4 weeks and 2 years. No spontaneous substantial recovery of lipoatrophic areas has been reported. Frequent use of the same pen needle and lack of rotating of insulin injection sites seem to favour the development of lipoatrophy.

Topics: Adult; Diabetes Mellitus, Lipoatrophic; Diabetes Mellitus, Type 1; Female; Humans; Hypoglycemic Agents; Insulin; Insulin Glargine; Insulin, Long-Acting; Lipodystrophy

Management of diabetes mellitus can be responsible for cutaneous adverse events. For example, lipoatrophy or lipohypertrophy can develop at the site of insulin injections. Lipohypertrophy remains a frequent complication of insulin therapy irrespective of the insulin source and mode of administration. Lipoatrophy at insulin injection sites is considered to be an immune complex-mediated inflammatory lesion; however, it has become a rare event since the advent of human insulin. Nowadays, continuous subcutaneous insulin infusion (CSII) using a portable pump and/or injections of insulin analogs with an altered amino acid sequence compared with native insulin may cause lipodystrophy in diabetic patients. Some case reports describe the recovery of lipoatrophy following the use of CSII and/or short-acting insulin analogs. Conversely, exceptional cases of lipoatrophy have occurred in patients receiving lispro insulin analog via CSII. Lipodystrophy reactions remain a potential problem when managing diabetic patients with new insulin therapy technologies.

Topics: Abdomen; Humans; Hypoglycemic Agents; Insulin; Insulin Glargine; Insulin Infusion Systems; Insulin Lispro; 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