Allergy to soft cannula of insulin pump in diabetic patient

Non-glycemic Adverse Effects of Insulin

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.

Rapid Desensitization for Insulin Allergy in Type 1 Diabetes Using an Insulin Pump: A Case Report and Literature Review

Objective

Insulin allergy, although uncommon, poses a significant challenge in those with type 1 diabetes mellitus (T1D) as insulin replacement is a necessity. Our objective is to describe a patient in whom rapid desensitization to insulin aspart was achieved using an insulin pump.

Methods

A 40-year-old woman with newly diagnosed T1D developed pruritic wheals over the abdomen after being injected with insulin glargine U-300 (Toujeo) and insulin aspart. Type 1 insulin hypersensitivity was confirmed through intradermal testing and positive insulin-specific immunoglobulin E levels.

Result

The patient underwent rapid desensitization with an insulin pump. Half the anticipated daily basal requirement was initially subcutaneously administered before initiating low-dose insulin via the pump (0.000025 units/h) and increasing the dose every 30 minutes to reach her basal requirements within 5 hours. Subsequent larger bolus insulin doses did not produce any local or anaphylactic reactions. No pretreatment with corticosteroids or antihistamines was provided.

Conclusion

Previous protocols for insulin desensitization span over days and often involve routine premedication. The case we presented suggests that insulin desensitization can be achieved over several hours using an insulin pump. A subcutaneous basal insulin cover should be provided prior to desensitization to avoid hyperglycemia necessitating an insulin bolus. Routine premedication may not always be necessary depending on reaction severity.

Cutaneous Adverse Effects of Diabetes Mellitus Medications and Medical Devices: A Review

Diabetes mellitus is one of the most prevalent chronic diseases in the USA. If uncontrolled, diabetes can lead to devastating complications. Diabetes medications and medical devices largely contribute to the significant financial expense that the disease inflicts on affected individuals and society. Alongside significant economic burden, there are numerous cutaneous adverse effects associated with diabetes medications and medical devices. Despite the large and increasing number of individuals living with diabetes and the wide use of the related medications and medical devices, there is limited literature that comprehensively documents their cutaneous adverse effects. These cutaneous adverse effects are significant as they can worsen glycemic control, increase disease distress, and may increase risk of associated complications. Thus, it is important that providers can recognize these cutaneous adverse effects, identify the culprit agents, and can properly manage them. In this article, we provide a critical review of the cutaneous adverse effects of medications and devices used in the management of diabetes and provide insight into risk factors and prevention and an overview of therapeutic management. An emphasis is placed on clinical recognition and treatment for use of the medical providers who, regardless of practice setting, will treat patients with diabetes.

Skin-Related Complications Among Adolescents With Type 1 Diabetes Using Insulin Pump Therapy

Background

To identify the skin-related complications in adolescents with type 1 diabetes (T1D) using the insulin pump therapy (IPT).

Methods

A total of 64 T1D adolescents (between ages 13 and 19) using the insulin pump were included in this cross-sectional study. They had visited the Diabetes Clinic at Diabetes Treatment Center, Prince Sultan Military Medical City, Saudi Arabia, for treatment from January 2018 to March 2018. Data on the prior and present skin-related complications, for a 6-month interval, were gathered via a closed/structured questionnaire. Besides this, demographic information was also recorded.

Results

From the patients in this study (n = 64), 9.3% experienced 3 or more skin-related complications, whereas 7.8% patients registered 2 and 25% had only 1 such disorder. However, in 37 patients (51.8%), there was no evidence of skin-related complications. Significantly, the female revealed a higher level of issues (P = .036), >3 years on IPT (P = .039), negligence of infusion set rotation (P = .001), needle length of 9 mm (P = .021), and beyond 3 days for catheter replacement (P = .022). The factors age, body mass index, diabetes duration, and insulin dosage remained quite unaffected. From the regression analysis, the factors female gender, catheter replacement, and infusion set rotation showed up as the independent risk factors for the skin complications.

Conclusions

The IPT users invariably experience dermatologic conditions. Through this study, female gender, length of IPT usage time, and infusion set rotations were identified as the independent risk factors responsible for the skin issues.