Insulin Oedema and its Clinical Significance: Metabolic Studies in Three Cases

Abstract

Three patients with insulin-dependent diabetes mellitus are described in whom generalized oedema and weight gain followed the administration of excessive monocomponent insulins, in two cases associated with symptomatic hypoglycaemia. Serial measurements of plasma volume and transcapillary escape rate of albumin (TERA) using 125I-labelled albumin, serum colloid osmotic pressure (COP) using a membrane colloid osmometer, packed cell volume (PCV), and serum proteins, showed that oedema was associated with an increased plasma volume and TERA, while serum albumin and total protein concentration and serum COP were reduced. A reduction in daily insulin dose abolished hypoglycaemia and resulted in weight loss, natriuresis, diuresis, a reduction in plasma volume and TERA, and an increase in serum albumin, total protein, and COP. Strict metabolic control in previously poorly controlled patients may cause insulin-induced increments in plasma volume and albumin escape rate.

Type 1 Diabetes Mellitus and Co-Morbidities

“…Transient inappropriate hyperaldosteronism has also been suggested to contribute to the fluid retention (Bas et al, 2010). Loss of albumin from the circulation due to increased transcapillary leakage probably contributed to the formation of oedema and the decreased serum albumin, but was not severe enough to account for the magnitude of oedema (Wheatly & Edwards 1985). Cases with normal serum albumin have also been reported.…”

Effective Treatment of Insulin-Induced Edema Using Ephedrine

“…Insulin also increases vascular permeability in subjects with uncomplicated diabetes (10). Increased losses of albumin from the circulation have been postulated to contribute to the formation of edema, a hypothesis supported by the increase in transcapillary escape of albumin demonstrated in 3 subjects with insulin-induced edema (4).…”

A very rare complication of type 1 diabetes: insulin edema developed in a newly diagnosed type 1 diabetes

“…insulin tedavisiyle birlikte glükagon hormonun baskilanmasinin böbreklerden sodyum ve sivi atilimini azalttigi bilinmektedir (14). Hem diyabet hastalarmda hem de saglikli kontrollerde insulin hormonunun kapiller geçirgenligi artirdigi, dola §imda azalan albumin düzeylerinin ödem geli §imine katki sagladigmi gösteren çaliçmalar bulunmaktadir (15,16). Olgumuzun serum albumin, plazma renin ve aldosteron düzeyleri normal smirlarda bulunsa da, idrar sodyum atilimmin alt sinira yakin, hafif azalmi § olmasi yukaridaki mekanizmalarm ödem geli §iminde rol oynami § Çekil 1.…”

“…Nitekim serum aibümin düzeyi normal oldugu halde insuline bagli ödem geli §tigi bildirilmi §tir (1). Ba §ka çaliçmalarda da insulin tedavisinin albumin düzeylerinde azalmaya yol açsa da bunun ödem geli §imi için yeterli olmayacagi ileri sürülmü §tür (3,16). ilginç olarak bizim olgumuzda da, daha önce insuline bagli ödem geliçtigi bildirilen bazi olgularda oldugu gibi boya göre vücut agirliginm dü §ük oldugu gözlenmi §tir (1,3,17).…”