Human Insulin–Induced Lipoatrophy
A successful treatment with glucocorticoid
- Endocrinology and Diabetes Unit, Department of Preventive Social and Internal Medicine, Alcides Carneiro University Hospital, Federal University of Campina Grande, Campina Grande, Paraiba, Brazil
- Address correspondence and reprint requests to Alberto José Santos Ramos, MD, Endocrinology and Metabology Clinic, Sandra Borborema Street, 61, Downtown, 58102-375, Campina Grande, Paraiba, Brazil. E-mail: ajsr{at}uol.com.br
Before the development of purified insulin in the 1970s, lipoatrophy was a common complication of insulin therapy (1,2). With the arrival of human insulin, lipoatrophy has decreased dramatically, becoming a rare problem in clinical practice. Lipoatrophies are considered an adverse immunological side effect of insulin therapy, and in some cases they are mediated by a local high production of tumor necrosis factor-α, which leads to a dedifferentiation of adipocytes in the subcutaneous tissue. The treatment with corticosteroids is useful because of its immunomodulating properties and also because it is able to produce a differentiation of adipocytes (2–4).
In most reported cases of insulin-induced lipoatrophies, there were attempts of changing the injection areas without any evidence of improvement (5–8). Kumar et al. (9) in a single-blind study used small amounts of dexamethasone, adding 4 μg/unit to insulin injections, in nine patients with marked lipoatrophy in both thighs. A mix of insulin and dexamethasone was injected into one thigh and insulin without dexamethasone was injected into the other. This way, each patient was her own control subject. Six patients showed significant improvement. None used …
