Insulin induced lipodystrophy
AbstractInsulin induced lipoatrophy and, more commonly, lipohypertrophy are dermatological complications of insulin therapy. Lipoatrophy is becoming less common with the advent of newer insulin analogues; however, lipohypertrophy is still prevalent. Whilst an immunological mechanism is postulated for lipoatrophy, direct local anabolic action of insulin is postulated for lipohypertrophy. Other factors which are implicated are the duration of diabetes, the number of insulin injections, re-use of needles and pen devices. The best current preventative and therapeutic strategies for insulin induced lipohypertrophy include rotation of injection sites with each injection and non-reuse of needles. Topical dexamethasone injections have been tried for the management of insulin induced lipoatrophy. It is important that these complications are recognised and managed appropriately. Insulin absorption from these sites is unpredictable and can lead to erratic glycaemic levels and unpredictable hypoglycaemic attacks. This article raises awareness of the possibility of insulin induced lipodystrophy as a cause of poor glycaemic control.
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