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Diabetes Care Publish Ahead of Print published online ahead of print December 27, 2007
DOI: 10.2337/dc07-1739
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Original Research

Human Insulin Analog Induced Lipoatrophy

Ximena Lopez, MD1,,3, Mariana Castells, MD2,,3, Alyne Ricker, MD1,,3, Elsa F. Velazquez, MD2,,3, Edward Mun, MD2,,3 and Allison B. Goldfine, MD1,,3

1Joslin Diabetes Center,
2Brigham and Woman's Hospital,
3Harvard Medical School, Boston, Massachusetts

Allison.Goldfine{at}Joslin.Harvard.Edu

ABSTRACT

Objective: To characterize pathophysiology of recombinant human insulin-induced lipoatrophy.

Research Design and Methods: We performed immunologic laboratory evaluation and skin testing for different insulin analogs and diluents in patients with type 1 diabetes and severe insulin-induced local lipoatrophy. Subcutaneous adipose tissue biopsies of areas of acute (7 days) and chronic insulin administration were examined. Topical sodium cromolyn was applied twice a day to atrophic areas and prophylactically to new sites of insulin administration.

Results: Subcutaneous adipose biopsies showed an elevated population of tryptase-positive, chymase-positive degranulated mast cells. Of 5 patients treated with topical sodium cromolyn, none had new lipoatrophic sites and 4 showed improvements in old lesions.

Conclusions: Tryptase positive/chymase postitive mast cells, known to be sensitive to sodium cromolyn, may contribute to the destructive immune process mediated in response to exogenous insulin. Mast cell stabilizing therapy with topical cromolyn may reverse early and prevent new lipoatrophic lesions.


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Copyright © 2007 by the American Diabetes Association.