Insulin Oedema in Newly Diagnosed Type 1 Diabetes Mellitus

Abstract

Despite the essential role of insulin in the management of patients with insulin deficiency, insulin use can lead to adverse effects such as hypoglycaemia and weight gain. Rarely, crucial fluid retention can occur with insulin therapy, resulting in an oedematous condition. Peripheral or generalised oedema is an extremely rare complication of insulin therapy in the absence of heart, liver or renal involvement. It has been reported in newly diagnosed type 1 diabetes, in poorly controlled type 2 diabetes following the initiation of insulin therapy, and in underweight patients on large doses of insulin. The oedema occurs shortly after the initiation of intensive insulin therapy. We describe two adolescent girls with newly diagnosed type 1 diabetes, who presented with oedema of the lower extremities approximately one week after the initiation of insulin treatment; other causes of oedema were excluded. Spontaneous recovery was observed in both patients.Conflict of interest:None declared.

The effects of transdermal insulin treatment of streptozotocin-induced diabetic rats on kidney function and renal expression of glucose transporters

“…Insulin-containing dermal patches increased urinary Na + excretion of STZinduced diabetic rats in contrast to hyperinsulinemic edema and hypertension due to increased Na + retention associated with intensive insulin therapy. 8 Our study shows that transdermal PI matrix patches can reverse the previously reported inability of the kidney to excrete Na + in STZ-diabetes mellitus. [30][31][32] Hyperinsulinemic edema and hypertension associated with intensive insulin therapy have been attributed, at least in part, to Na + retaining action of insulin.…”

“…[30][31][32] Hyperinsulinemic edema and hypertension associated with intensive insulin therapy have been attributed, at least in part, to Na + retaining action of insulin. 8 However, literature evidence on the effects of insulin on kidney function in diabetes is conflicting and remains unclear. It would appear that renal effects of insulin depend on endogenous levels of circulating insulin and on the availability of insulin-binding sites in the kidney.…”

“…On the other hand, bolus iv, sc or im insulin injections elicit relatively high plasma levels of insulin which are exposed to peripheral organs and probably cause hyperinsulinemic edema and hypertension. 8 The invasive PI dermal patches may offer minimally invasive insulin delivery in clinical applications to perhaps improve insulin bioavailability and patient compliance.…”

“…Furthermore, reports indicate that the intensive therapy is associated with increased Na + retention resulting in hyperinsulinemic edema and hypertension. 8 Other therapeutic interventions such as metformin, insulin secretagogues do not achieve glycemic targets and thus the search for new treatment strategies is ongoing. We have reported that insulin-containing dermal patch formulation sustains slow controlled release of insulin into the bloodstream of diabetic rats with a concomitant reduction of blood glucose concentrations.…”

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

“…The first case of insulin oedema in a child with diabetes was described by Lawrence2 in 1979. Since then, 12 cases of insulin oedema in children have been reported 3 4…”