Effective Treatment of Insulin-Induced Edema Using Ephedrine

Hopkins, David; Cotton, Stephen J.; Williams, G. Melville

doi:10.2337/diacare.16.7.1026

Cited by 40 publications

(38 citation statements)

References 9 publications

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“…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 oedematous state develops briefly after the initiation of intensive insulin therapy (2, 3, 4). The pathophysiology remains vague, although the condition was first described as early as 1928 (3).…”

Section: Introductionmentioning

confidence: 99%

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Insulin Oedema in Newly Diagnosed Type 1 Diabetes Mellitus

Baş¹,

Çeti̇nkaya²,

Ağladıoğlu³

et al. 2010

JCRPE

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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.Conflict of interest:None declared.

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Section: Introductionmentioning

confidence: 99%

“…The oedematous state develops briefly after the initiation of intensive insulin therapy (2, 3, 4). The pathophysiology remains vague, although the condition was first described as early as 1928 (3). Reported cases of insulin-induced oedema in childhood and adolescence are scarce (1, 5).…”

Section: Introductionmentioning

confidence: 99%

Insulin Oedema in Newly Diagnosed Type 1 Diabetes Mellitus

Baş¹,

Çeti̇nkaya²,

Ağladıoğlu³

et al. 2010

JCRPE

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“…If there is evidence of malnutrition, thiamine supplementation should be initiated [1]. Diuretic use with furosemide 40 mg once daily, bumetanide 1 mg per day or spironolactone 100 mg per day have been tried with variable success [1,2,9,10]. There have been a few reported successfully treated cases of initiating vasoactive drugs, such as ephedrine 15 mg per day divided over three doses, in severe edema resistant to diuretics [1,9,10].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Cause of Generalized Insulin Edema and Truncal Neuropathy

Tufton

Huda

2015

J Med Cases

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Insulin edema and acute neuropathy are rare side effects of insulin initiation or rapid improvement in glycemic control. Both conditions occurring simultaneously are very rare and there are no previous data on truncal neuropathy as a dominant feature. A 35-year-old lady, who presented with an infected, necrotic fourth finger and was admitted for debridement and antibiotics, developed diabetic ketoacidosis. Past medical history included latent autoimmune disease of adults. She was non-compliant with medication and had experienced significant weight loss (37 kg; body mass index (BMI) 15.1 kg/m 2 ). She was glutamic acid decarboxylase antibody positive, with poor glycemic control (HbA1c 133 mmol/mol (14.3%)). She was treated with intravenous and then subcutaneous insulin. From day 3, she developed significant pitting edema to her umbilicus. She was treated with furosemide 40 mg once daily and fluid restriction. Other causes of edema were excluded. Peak weight gain was 5 kg and edema resolved 2 weeks later. She also developed a painful sensory neuropathy over dermatomes T12-L2 on day 5, which persisted for several months before resolution. Magnetic resonance imaging was normal and nerve conduction studies showed generalized diabetic sensorimotor neuropathy. This is the first report of edema and truncal neuropathy developing secondary to insulin initiation and a rapid improvement in glycemic control. Our case was particularly susceptible due to poor glycemic control, low bodyweight, hepatic dysfunction and low serum albumin. This case highlights the importance of being aware of the rare complications of insulin therapy, particularly in susceptible patients.

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“…Insulin edema is a rare complication of insulin therapy primarily seen with newly diagnosed or uncontrolled diabetes (1–3). Patients at risk are those who are beginning insulin treatment, underweight, or increasing their insulin dose either in the normal course of the disease or after diabetic ketoacidosis (1,4).…”

mentioning

confidence: 99%

“…It often resolves without intervention; however, a reduction in insulin dose may resolve the edema (1). Short-term diuretic therapy, salt restriction, or ephedrine has been studied and shown to be effective in correcting acute edema (1,3). Insulin edema can be difficult to diagnose with concomitant disease states and medications, but the possibility of insulin edema occurring in a patient should be considered with insulin nonadherence and whenever starting or increasing an insulin dose.…”

mentioning

confidence: 99%