Bilateral cataracts and insulin oedema in a child with type 1 diabetes mellitus

Abstract

SUMMARYWe describe a teenage type 1 diabetic girl with painless pedal oedema and bilateral cataracts. She developed oedema after commencement of intensive insulin therapy and achievement of excellent glycaemic control. In addition, she was also found to have bilateral subcapsular cataracts. The oedema subsided spontaneously and she underwent surgical treatment for the cataracts. Insulin oedema is a rare complication of insulin therapy. To our knowledge, co-occurrence of these two complications in a young diabetic patient has not been described before in the English language medical literature. BACKGROUND

Bilateral cataracts as the first manifestation of type 1 diabetes mellitus

“…The clinical characteristics of the patient, including age, gender, long-term diabetic symptoms, high glycosylated hemoglobin levels, and diabetic ketosis, support the diagnosis of diabetic cataracts. [ 4 , 9 , 11 ]…”

Cataract as Early Ocular Complication in Children and Adolescents with Type 1 Diabetes Mellitus

“…The pathophysiological mechanism of early diabetic cataract has not been fully understood; however, there are many theories about the possible etiology of diabetic cataract early in childhood [ 14 , 16 ]. Long-lasting hyperglycemia with consequential ketoacidosis and dehydration certainly plays an important role in the development of early diabetic cataract [ 5 , 18 ]. Even though the majority of newly diagnosed pediatric patients with T1DM have aforementioned symptoms, only a small number of patients develop early diabetic cataract [ 16 ].…”

“…The same group of authors describes the appearance of ketoacidosis as a sign of decompensated T1DM in all patients, which is in accordance with majority of older publications [ 15 ]. Interestingly, more recent findings suggest a smaller occurrence of ketoacidosis [ 17 , 18 ]. Furthermore, there is a significant variability regarding the level of hemoglobin A1c (HbA 1c ) at the diagnosis of diabetes itself, but also at the onset of early diabetic cataracts [ 3 , 8 , 9 ].…”

“…Regarding morphology of early diabetic cataract, Wilson et al reported multiple morphologies including posterior subcapsular, lamellar, cortical, snowflake, and milky white type of early diabetic cataract, while most of other authors discriminate fewer types with posterior subcapsular cataract described as the most common type of diabetic cataract in childhood [ 5 , 9 , 14 , 17 , 18 ].…”

Cutaneous manifestations of diabetes mellitus in children

“…А. Goturu и соавт. [18] сообщили о случае сочетания двух осложнений са-харного диабета 1-го типа у девочки-подростка: инсу-линовых отеков и двусторонней катаракты.…”