Generalised insulin oedema after intensification of treatment with insulin analogues

Adamo, Luigi; Thoelke, Mark

doi:10.1136/bcr-2012-007037

Cited by 15 publications

(11 citation statements)

References 10 publications

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“…In previous case reports, patients with insulin-induced edema were substantially malnourished or underweight [3,5,6]. Our patient, who had longstanding diabetes, was not insulin naive and had excessive body weight prior to the development of edema.…”

Section: Discussionmentioning

confidence: 59%

“…It has been described following the initiation or intensification of insulin treatment in known or newly diagnosed people with diabetes [1,2]. This complication presents with localized lower extremity edema or, less frequently, generalized edema [1,3]. Being a diagnosis of exclusion, insulin edema may be underreported, and due to its rare incidence it is generally not included in the differential diagnosis of edema, which can result in delayed diagnosis and treatment.…”

Section: Introductionmentioning

confidence: 99%

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Insulin Edema With Use of U-500 Regular Insulin in a Hybrid Closed-Loop Insulin Pump

Vasigh

Mohammady

Hopkins

2020

Cureus

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Insulin edema is a rare complication of insulin therapy which has been described in known or newly diagnosed people with diabetes, following initiation or intensification of insulin treatment. Here we present a 63-year-old man with complaints of weight gain, shortness of breath, and lower extremity edema starting two weeks after the change of his insulin pump to the hybrid closed-loop insulin pump system and substitution of U-100 aspart insulin with U-500 regular insulin. Laboratory studies, imaging, and electrocardiogram (EKG) were performed to evaluate the cause of acute edema and were all normal. Hemoglobin A1C showed remarkable improvement after the pump change and the insulin pump download showed a significant increase in the amount of total daily insulin administered. With the exclusion of other causes of acute edema, the patient was diagnosed with insulin edema. He was started on spironolactone 50 mg/daily and showed a desirable improvement of edema on follow-up. This case shows that although the use of the hybrid insulin-pump system helps to obtain better control of diabetes in many patients, the rapid improvement in glycemic control may precipitate the development of insulin edema. Furthermore, the use of high concentration insulin in insulin pumps is off-label and their use might increase the rate of complications of insulin therapy including insulin edema.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Insulin Edema With Use of U-500 Regular Insulin in a Hybrid Closed-Loop Insulin Pump

Vasigh

Mohammady

Hopkins

2020

Cureus

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“…It was initially reported in 1928 in a 41-year-old male patient, following which subsequently reported cases were few and far in between [1]. Recently, this finding was shown to occur after the intensification of insulin, not just after initiation [2]. The true incidence of insulin edema remains unknown but some reports have estimated it to be in the range of 3%-3.5% [3][4].…”

Section: Discussionmentioning

confidence: 98%

Anasarca in Newly Diagnosed Type 1 Diabetes: Review of the Pathophysiology of Insulin Edema

Wong

Balakrishnan

2020

Cureus

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“…It commonly occurs in individuals who are newly diagnosed with diabetes or in those with uncontrolled type 2 diabetes; it is usually a self-limiting condition but can recur or progress to frank congestive heart failure [ 11 ]. It tends to occur in Black women with underweight and can be associated with low albumin levels and/or de-ranged liver function [ 3 , 13 ]. It can also occur in patients with type 1 diabetes when they start insulin therapy, regardless of their glycemic control.…”

Section: Discussionmentioning

confidence: 99%

Insulin-Induced Edema in a Patient with Type 2 Diabetes Mellitus

Elmahal

Ramadan

2021

Am J Case Rep

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Patient: Female, 35-year-old Final Diagnosis: Diabetes mellitus type 2 Symptoms: Edema of lower limbs • edema of the face Medication: Insulin glargine Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Rare disease Background: The strong association between type 2 diabetes and obesity has been well recognized. Insulin treatment is usually needed at some point in the treatment of patients with type 2 diabetes and obesity to achieve the targeted glycemic control goal. Case Report: A 35-year-old woman who had gastric banding for morbid obesity 1 year prior presented to the outpatient clinic with recent onset of shortness of breath and bilateral ankle edema, which were thought to be of cardiac origin. Band slippage occurred a few months after the procedure, and the patient gained weight rapidly thereafter. She had been diagnosed with type 2 diabetes mellitus 8 years earlier, which was treated with oral hypoglycemic medication. Thyroid function tests done 4 months prior to her current presentation revealed normal results. A cardiac assessment showed normal cardiac function with no evidence of heart failure. Repeated thyroid function testing showed new-onset subclinical hypothyroidism. The patient had started insulin therapy 2 weeks before her current presentation, which was probably the main cause of her edema. While continuing insulin, the patient’s general condition improved with diuretics therapy, following which she had gastric bypass surgery. Conclusions: Insulin-induced edema is an under-diagnosed problem. It should be considered whenever a patient with uncontrolled diabetes develops rapid body swelling after initiation of insulin therapy. Rigorous research is needed to explore the pathophysiology, prevalence, and treatment of insulin-induced edema.

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Generalised insulin oedema after intensification of treatment with insulin analogues

Abstract: We report a case of generalised insulin oedema after intensification of treatment with genetically modified insulin. This is the first case of generalised oedema in response to treatment with insulin analogues in a patient not insulin naive.

Cited by 15 publications

References 10 publications

Insulin Edema With Use of U-500 Regular Insulin in a Hybrid Closed-Loop Insulin Pump

Insulin Edema With Use of U-500 Regular Insulin in a Hybrid Closed-Loop Insulin Pump

Anasarca in Newly Diagnosed Type 1 Diabetes: Review of the Pathophysiology of Insulin Edema

Insulin-Induced Edema in a Patient with Type 2 Diabetes Mellitus

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