1
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Janchevska A, Jovanovska V, Jordanova O, Beqiri-Jashari A, Krstevska-Konstantinova M, Tasic V, Gucev ZS. Peripheral Insulin Edema and Pericardial Effusion in a 12-Year-Old Newly Diagnosed Girl with Type 1 Diabetes. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:171-174. [PMID: 37453114 DOI: 10.2478/prilozi-2023-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Introduction: Insulin induced edema (IIE) is a rare condition, usually found in newly diagnosed diabetes patients, either after insulin treatment initiation or after dose increment. It is a self-limited process, rarely associated with serosal effusions. Teenage girls with type 1 diabetes (T1DM) are most commonly affected. Patient and Methods: A 12-year-old girl was diagnosed with ketoacidosis (DKA). Seven days after initiation of the insulin treatment, at a stable total daily dose of insulin (TDDI) of 0.55 IU/kg, she came with two kilograms weight gain in only two days and edema of the feet and calves. Ultrasound of the heart found a 7 mm pericardial effusion. The diagnostic workout included clinical examination, biochemical, hormonal, allergen analyses and imaging which excluded other known causes of swelling. Conclusions: We describe an adolescent girl with newly diagnosed T1DM and a rare association of peripheral insulin-induced edema and pericardial effusion. Short-term diuretic treatment and salt restriction resolved this rare complication of insulin treatment.
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Affiliation(s)
- Aleksandra Janchevska
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
| | - Valentina Jovanovska
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
| | - Olivera Jordanova
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
| | - Ardiana Beqiri-Jashari
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
| | | | - Velibor Tasic
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
| | - Zoran S Gucev
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
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2
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Fröhlich-Reiterer E, Elbarbary NS, Simmons K, Buckingham B, Humayun KN, Johannsen J, Holl RW, Betz S, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes 2022; 23:1451-1467. [PMID: 36537532 DOI: 10.1111/pedi.13445] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | - Kimber Simmons
- Barbara Davis Center for Diabetes, University of Colorado, Denver, Colorado, USA
| | - Bruce Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University Medical Center, Stanford, California, USA
| | - Khadija N Humayun
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jesper Johannsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Herlev and Steno Diabetes Center Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Shana Betz
- Parent/Advocate for people with diabetes, Markham, Canada
| | - Farid H Mahmud
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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3
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Vasigh M, Hopkins R. Insulin edema after initiation of hybrid closed-loop insulin pump therapy with continuous glucose monitoring: a case report. Clin Diabetes Endocrinol 2022; 8:6. [PMID: 36180933 PMCID: PMC9524106 DOI: 10.1186/s40842-022-00143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Insulin edema is a rare complication which can present after initiation or intensification of insulin therapy in people with diabetes. Initiation of closed-loop hybrid insulin pump therapy can result in rapid improvement in glycemic control for people with diabetes. We present a case in which transition to a closed-loop hybrid insulin pump system, followed by significant improvement in glycemic control, led to development of insulin edema in a person with type 1 diabetes. CASE PRESENTATION We present a 51-year-old woman with type 1 diabetes of 16 years duration, on insulin pump therapy for more than 10 years, who presented for follow-up 7 weeks after transitioning to a hybrid closed-loop insulin pump system with continuous glucose monitoring (CGM). She complained of weight gain and bilateral lower extremity edema which had started two weeks after the change in pump modality. Laboratory studies and echocardiogram did not reveal any etiology of the acute edema. HbA1c was 3.3% lower than the previous measurement 15 weeks earlier, and there was a significant increase in the daily total insulin dose. With exclusion of other causes of acute edema, the patient was diagnosed with insulin edema and started on hydrochlorothiazide. On follow up, her lower extremity edema significantly improved although her weight did not return to baseline. CONCLUSION To our knowledge, this is the first case of insulin edema reported in a person with type 1 diabetes using CGM and a hybrid closed-loop insulin pump system. The increase in total daily insulin dose, rapid improvement of glycemic control, and lack of hypoglycemic episodes were important factors to consider in evaluation of this case. Use of hybrid closed-loop systems can help achieve rapid improvement in glycemic control in people with diabetes. This case suggests that consideration should be given to adjusting initial blood glucose targets when starting these remarkable new technologies in people with baseline poor glycemic control.
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Affiliation(s)
- Mostafa Vasigh
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Rachel Hopkins
- Department of Medicine, Division of Endocrinology, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA.
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4
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Insulin Edema Syndrome due to Rapid Glucose Correction in a Diabetic Patient. Case Rep Med 2022; 2022:3027530. [PMID: 36017419 PMCID: PMC9398878 DOI: 10.1155/2022/3027530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/11/2022] [Accepted: 06/29/2022] [Indexed: 11/21/2022] Open
Abstract
Edema resulting from the initiation of insulin therapy or intensification of glycemic control is a rare and under-recognized complication. In this report, we present a case of a 46-year-old patient with insulin-dependent diabetes mellitus (IDDM) who avoided insulin treatment due to associated peripheral edema. Though rare, this phenomenon is typically seen in patients with elevated glucose levels who are initiated on insulin treatment, resulting in rapid correction and tight control of glucose levels. The diagnosis of insulin-induced edema is made after other causes of acute edema are ruled out. Furthermore, in this case report, we will also discuss the postulated mechanisms for the edema-causing property of insulin.
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5
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Pudupakkam A, Hashim F, Stephen M, Blasick S. An adolescent with newly diagnosed diabetes mellitus presenting with edema: Answers. Pediatr Nephrol 2022; 37:1797-1798. [PMID: 35118541 DOI: 10.1007/s00467-022-05463-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
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6
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Pauley ME, Tan S, Sikand G, Cobry EC. Severe, Refractory Insulin Edema With Cardiopulmonary Congestion Requiring Multiple Treatment Modalities in an Adolescent With Known Type 1 Diabetes. Clin Diabetes 2022; 40:253-256. [PMID: 35669309 PMCID: PMC9160534 DOI: 10.2337/cd21-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Meghan E. Pauley
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
- Corresponding author: Meghan E. Pauley,
| | - Suyuan Tan
- Kansas City University College of Osteopathic Medicine, Kansas City, MO
| | | | - Erin C. Cobry
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
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7
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Guarneri AM, Hoffman RP. Non-glycemic Adverse Effects of Insulin. Curr Diabetes Rev 2022; 18:e012821190877. [PMID: 33511950 DOI: 10.2174/1573399817666210129104420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/22/2022]
Abstract
Insulin is primarily considered for its glycemic effects in patients with diabetes. There are, however, non-glycemic adverse effects of insulin that may significantly impact patient health and interfere with glycemic control. Insulinogenic edema primarily occurs with rapid improvement in glycemic control either in patients with newly discovered diabetes or in patients with poorly-controlled diabetes. Insulin-induced sympathetic activation, vasodilation, changes in vascular permeability, and most importantly, sodium retention play significant etiologic roles in the development of edema. Clinically, it is usually self-limited, but significant complications can develop. Allergic reactions to all insulin preparations and various compounds used in insulin formulations with a wide range of severity have been reported. Frequently, changing the type of insulin or delivery method is sufficient, but more advanced treatments such as insulin desensitization and anti-IgE antibody treatment may be needed. Lipohypertrophy and lipoatrophy frequently develop with the overuse of injection sites. Lipohypertrophy can affect tissue insulin absorption and glycemic control.
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Affiliation(s)
- Alissa M Guarneri
- Department of Pediatrics Division of Endocrinology and Diabetes UPMC Children's Hospital of Pittsburgh University of Pittsburgh School of Medicine Pittsburgh, Pittsburgh, PA 15224, USA
| | - Robert P Hoffman
- Department of Pediatrics Division of Endocrinology Nationwide Children\'s Hospital The Ohio State University College of Medicine Columbus, OH 43205, USA
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8
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Takeda Y, Karashima S, Kometani M, Yoneda T. Penile and scrotal oedema along with urinary retention after insulin therapy. BMJ Case Rep 2021; 14:14/7/e240342. [PMID: 34301698 DOI: 10.1136/bcr-2020-240342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Insulin oedema is a rare complication of insulin treatment characterised by an absence of heart, liver and renal involvement. Insulin oedema typically develops in the lower extremities or, less frequently, as generalised oedema after initiation of insulin therapy. We report a 59-year-old man with poorly controlled type 2 diabetes who developed oedema in his penis and scrotum accompanied by weight gain following intensive insulin therapy. His oedema improved after reduction of the daily insulin injection dose and treatment for urinary retention. Penile and scrotal oedema is a rare physical finding for the patient with diabetes. Therefore, in patients with poorly controlled diabetes who have started insulin therapy, physicians should pay attention to urinary retention and do not miss changes in weight gain or oedema in the lower body, including the perineal region.
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Affiliation(s)
- Yoshimichi Takeda
- Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Shigehiro Karashima
- Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Mitsuhiro Kometani
- Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Takashi Yoneda
- Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan .,Department of Health Promotion and Medicine of the Future, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
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9
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Xue J, Liu W, Shi F, Zheng J, Ma J. Pleural Effusion Due to Use of Pioglitazone: A Case Report. Metab Syndr Relat Disord 2020; 18:168-171. [PMID: 32250209 DOI: 10.1089/met.2019.0109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Jinhui Xue
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Wei Liu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Fanghong Shi
- Department of Pharmacy, Shanghai Jiao Tong University School of Medicine, Affiliated Renji Hospital, Shanghai, China
| | - Jun Zheng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Jing Ma
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
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10
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Wong M, Balakrishnan T. Anasarca in Newly Diagnosed Type 1 Diabetes: Review of the Pathophysiology of Insulin Edema. Cureus 2020; 12:e7234. [PMID: 32280575 PMCID: PMC7145382 DOI: 10.7759/cureus.7234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Insulin edema is a rare complication of insulin therapy that can occur after the initiation of insulin. Various timelines to the initiation of insulin have been reported after insulin therapy. Here, we report the occurrence of generalized edema in a 40-year-old woman early after the initiation of insulin. Significant differentials were excluded and resolution achieved after two weeks with diuretics. We reviewed the current literature and the possible mechanisms behind this phenomenon.
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Affiliation(s)
- Marc Wong
- Internal Medicine, Singapore General Hospital, Singapore, SGP
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11
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Abstract
A 38-year-old South Asian woman with a long-standing history of poorly controlled diabetes was admitted with severe oedema. Two weeks earlier, she had been treated with insulin for uncomplicated diabetic ketoacidosis. Renal, liver and cardiac causes of oedema were excluded, and it was assumed she may have developed 'insulin oedema'. She responded well to oral diuretics and symptoms resolved within a few weeks. Insulin oedema is an uncommon cause of oedema in patients recently commenced on insulin therapy.
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12
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Derya Bulus A, Andiran N, Osman Köksal A. Insulin Edema in Type 1 Diabetes Mellitus: Report of a Case and Brief Review of the Literature. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e5077. [PMID: 27713813 PMCID: PMC5045534 DOI: 10.5812/ijp.5077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/09/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Ayse Derya Bulus
- Department of Endocrinology, Kecioren Training and Research Hospital, Ankara, Turkey
- Corresponding author: Ayse Derya Bulus, Department of Endocrinology, Kecioren Training and Research Hospital, Ankara, Turkey. Tel: +90-5326335052, Fax: +90-3569002, E-mail:
| | - Nesibe Andiran
- Department of Endocrinology, Kecioren Training and Research Hospital, Ankara, Turkey
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13
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Iafusco D, Piscopo A, Confetto S, Cocca A, Pezzino G, Caredda E, Casaburo F, Villano P, Russo L, Zanfardino A, Prisco F. Lower limbs edema by insulin glargine treatment: two other cases in pediatrics. Acta Diabetol 2016; 53:503-5. [PMID: 26239143 DOI: 10.1007/s00592-015-0797-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 07/13/2015] [Indexed: 01/12/2023]
Affiliation(s)
- Dario Iafusco
- Department of Pediatrics, Second University of Naples, Via S.Andrea delle Dame, 4, 80138, Naples, Italy.
| | - Alessia Piscopo
- Department of Pediatrics, Second University of Naples, Via S.Andrea delle Dame, 4, 80138, Naples, Italy
| | - Santino Confetto
- Department of Pediatrics, Second University of Naples, Via S.Andrea delle Dame, 4, 80138, Naples, Italy
| | - Alessandra Cocca
- Department of Pediatrics, Second University of Naples, Via S.Andrea delle Dame, 4, 80138, Naples, Italy
| | - Giulia Pezzino
- Endocrinology, Department of Clinical and Molecular Bio-Medicine, Garibaldi-Nesima Hospital, University of Catania, Via Palermo 636, 95122, Catania, Italy
| | - Elisabetta Caredda
- Department of Pediatrics, Second University of Naples, Via S.Andrea delle Dame, 4, 80138, Naples, Italy
| | - Francesca Casaburo
- Department of Pediatrics, Second University of Naples, Via S.Andrea delle Dame, 4, 80138, Naples, Italy
| | - Pasquale Villano
- Department of Pediatrics, Second University of Naples, Via S.Andrea delle Dame, 4, 80138, Naples, Italy
| | - Loredana Russo
- Department of Pediatrics, Second University of Naples, Via S.Andrea delle Dame, 4, 80138, Naples, Italy
| | - Angela Zanfardino
- Department of Pediatrics, Second University of Naples, Via S.Andrea delle Dame, 4, 80138, Naples, Italy
| | - Francesco Prisco
- Department of Pediatrics, Second University of Naples, Via S.Andrea delle Dame, 4, 80138, Naples, Italy
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14
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Greco D. Severe weight gain and generalized insulin edema after the starting of an insulin pump. Can J Diabetes 2015; 39:21-3. [PMID: 25282002 DOI: 10.1016/j.jcjd.2014.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 06/20/2014] [Accepted: 07/01/2014] [Indexed: 11/29/2022]
Abstract
The possibility of the occurrence of a generalized edema after initiation or intensification of insulin treatment in patients with diabetes, although considered a rare event, has long been described in the literature. In this case, a state of clinically significant edema, with a concurrent severe weight gain, occurred in a patient with type 1 diabetes in whom the implantation of an insulin pump resulted in a dramatic and abrupt improvement in glycemic control.
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Affiliation(s)
- Domenico Greco
- Division of Diabetology, Paolo Borsellino Hospital, Marsala, Italy.
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15
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Aravamudhan A, Gardner C, Smith C, Senniappan S. Insulin oedema in a child with newly diagnosed diabetes mellitus. Eur J Pediatr 2014; 173:685-7. [PMID: 23712377 DOI: 10.1007/s00431-013-2045-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/14/2013] [Indexed: 11/24/2022]
Abstract
Insulin oedema is a rare complication of insulin therapy for diabetes mellitus. It has been reported in type 1 diabetes mellitus, in poorly controlled type 2 diabetes mellitus following either the initiation or intensification of insulin therapy and in underweight patients on large doses of insulin. There are only a few case reports since it was first described in 1928, showing that it is an uncommon and probably an under-reported complication. The majority of those reports have been in the adult population. The generalised oedema tends to develop shortly after initiation or intensification of insulin therapy and resolves spontaneously within few weeks. We present one of the youngest patients reported in the literature, a 9-year-old boy who developed insulin oedema within few days of presenting with diabetic ketoacidosis. The case highlights the importance of recognising this generally transient and self-resolving complication and differentiating it from other serious causes of oedema.
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Affiliation(s)
- Avinash Aravamudhan
- Department of Paediatrics, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
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16
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Rothacker KM, Kaye J. Insulin oedema and treatment-induced neuropathy occurring in a 20-year-old patient with Type 1 diabetes commenced on an insulin pump. Diabet Med 2014; 31:e6-e10. [PMID: 23815567 DOI: 10.1111/dme.12271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/27/2013] [Accepted: 06/26/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oedema may occur following initiation or intensification of insulin therapy in patients with Type 1 and Type 2 diabetes. Mild oedema is thought to be not uncommon, but under-reported, whilst generalized oedema with involvement of serous cavities has rarely been described. Multiple pathogenic mechanisms have been proposed, including insulin-induced sodium and water retention. Patients at greater risk for insulin oedema include those with poor glycaemic control. Dramatic improvement in glycaemic control is also associated with sensory and autonomic neuropathy. CASE REPORT We describe a case of generalized oedema occurring in a 20-year-old, low body weight patient with Type 1 diabetes with poor glycaemic control 3 days following commencement of an insulin pump; blood sugars had dramatically improved with this treatment. Alternative causes for oedema were excluded. Oedema slowly improved with insulin dose reduction with higher blood sugar targets plus frusemide treatment. Subsequent to oedema resolution, the patient unfortunately developed generalized neuropathic pain, thought to be another manifestation of rapid improvement in glycaemic control. CONCLUSION Caution should be taken when a patient with diabetes that is poorly controlled has an escalation in therapy that may dramatically improve their blood sugar levels; this includes the initiation of an insulin pump. Clinicians and patients should be aware of the potential risk of insulin oedema, treatment-induced neuropathy and worsening of diabetic retinopathy in the setting of rapid improvement in glycaemic control.
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Affiliation(s)
- K M Rothacker
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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17
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Adamo L, Thoelke M. Generalised insulin oedema after intensification of treatment with insulin analogues. BMJ Case Rep 2013; 2013:bcr-2012-007037. [PMID: 23429012 DOI: 10.1136/bcr-2012-007037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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.
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Affiliation(s)
- Luigi Adamo
- Barnes Jewish Hospital/Washington University in St Louis, St Louis, Missouri, USA.
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18
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Insulin-induced electrophysiology changes in human pleura are mediated via its receptor. EXPERIMENTAL DIABETES RESEARCH 2010; 2010:853176. [PMID: 20814548 PMCID: PMC2931388 DOI: 10.1155/2010/853176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 06/16/2010] [Accepted: 07/02/2010] [Indexed: 11/23/2022]
Abstract
Background. Insulin directly changes the sheep pleural electrophysiology. The aim of this study was to investigate whether insulin induces similar effects in human pleura, to clarify insulin receptor's involvement, and to demonstrate if glibenclamide (hypoglycemic agent) reverses this effect.
Methods. Human parietal pleural specimens were mounted in Ussing chambers. Solutions containing insulin or glibenclamide and insulin with anti-insulin antibody, anti-insulin receptor antibody, and glibenclamide were used. The transmesothelial resistance (RTM) was determined. Immunohistochemistry for the presence of Insulin Receptors (IRa, IRb) was also performed. Results. Insulin increased RTM within 1st min (P = .016), when added mesothelially which was inhibited by the anti-insulin and anti-insulin receptor antibodies. Glibenclamide also eliminated the insulin-induced changes. Immunohistochemistry verified the presence of IRa and IRb.
Conclusion. Insulin induces electrochemical changes in humans as in sheep via interaction with its receptor. This effect is abolished by glibenclamide.
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19
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Baş VN, Çetinkaya S, Yılmaz Ağladıoğlu S, Peltek Kendirici HN, Bilgili H, Yıldırım N, Aycan Z. Insulin oedema in newly diagnosed type 1 diabetes mellitus. J Clin Res Pediatr Endocrinol 2010; 2:46-8. [PMID: 21274337 PMCID: PMC3005662 DOI: 10.4274/jcrpe.v2i1.46] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 11/05/2009] [Indexed: 12/01/2022] Open
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.
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Affiliation(s)
- Veysel Nijat Baş
- Dr. Sami Ulus Obstetrics and Gynecology, Childrens Health and Disease Training and Research Hospital, Department of Pediatric Endocrinology, Ankara, Turkey.
| | - Semra Çetinkaya
- Dr. Sami Ulus Women Health, Children's Education and Research Hospital Section of Pediatric Endocrinology, Ankara, Turkey
| | - Sebahat Yılmaz Ağladıoğlu
- Dr. Sami Ulus Women Health, Children's Education and Research Hospital Section of Pediatric Endocrinology, Ankara, Turkey
| | - Havva Nur Peltek Kendirici
- Dr. Sami Ulus Women Health, Children's Education and Research Hospital Section of Pediatric Endocrinology, Ankara, Turkey
| | - Hatice Bilgili
- Dr. Sami Ulus Women Health, Children's Education and Research Hospital Section of Pediatric Endocrinology, Ankara, Turkey
| | - Nurdan Yıldırım
- Dr. Sami Ulus Women Health, Children's Education and Research Hospital Section of Pediatric Endocrinology, Ankara, Turkey
| | - Zehra Aycan
- Dr. Sami Ulus Women Health, Children's Education and Research Hospital Section of Pediatric Endocrinology, Ankara, Turkey
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20
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [PMID: 18533281 PMCID: PMC7167700 DOI: 10.1002/pds.1487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of pharmacoepidemiology and drug safety. Each bibliography is divided into 20 sections: 1 Reviews; 2 General; 3 Anti‐infective Agents; 4 Cardiovascular System Agents; 5 CNS Depressive Agents; 6 Non‐steroidal Anti‐inflammatory Agents; 7 CNS Agents; 8 Anti‐neoplastic Agents; 9 Haematological Agents; 10 Neuroregulator‐Blocking Agents; 11 Dermatological Agents; 12 Immunosuppressive Agents; 13 Autonomic Agents; 14 Respiratory System Agents; 15 Neuromuscular Agents; 16 Reproductive System Agents; 17 Gastrointestinal System Agents; 18 Anti‐inflammatory Agents ‐ Steroidal; 19 Teratogens/fetal exposure; 20 Others. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.
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