Insulin-derived Amyloidosis and Poor Glycemic Control: A Case Series

Abstract

Insulin-derived amyloidosis caused poor glycemic control and increased insulin dose requirements because of impairments in insulin absorption.

Progressive insulin-derived amyloidosis in a patient with type 2 diabetes

“…[4] In Nagase’s report, they experienced seven cases in only one institute although only 11 cases have been reported in the English language literature. [2] Nagase suggested that insulin-derived amyloidosis may be a more common complication of insulin therapy than previously thought and a more common manifestation of amyloid-related disease. Injection into lipohypertrophy can reduce the effectiveness of insulin, although less markedly than injection into amyloid.…”

“…Patients with this disease suffer from hyperglycemia because insulin absorption is markedly impaired at the mass. [2] Consequently, their insulin dose requirements are increased. In contrast, severe hypoglycemia will occur when patients inject an increased dose of insulin into a normal site.…”

“…In contrast, severe hypoglycemia will occur when patients inject an increased dose of insulin into a normal site. [2] In a previous report, one patient had routinely injected insulin into such lesions, as they could be grasped easily, and injection was less painful than elsewhere. [1] It is possible that patients tend to inject into such lesions because of these features.…”

“…[1,2] This clinical entity is important because it causes deterioration of blood glucose control. [2] Despite its importance, it remains unclear whether the mass should be excised. Here, we report a case showing a progressive mass in the lower abdomen.…”

Insulin Shot Dependent Lipodystrophy: Evidence, Uncertainties and Current Terminology Overlaps

“…6 This distinction is especially important from a clinical perspective as, when injected into LA areas, insulin has much higher chances to reach into the subcutaneous muscle tissue, thus causing severe hypoglycemic events. An even rarer type of lipodystrophy is amyloidosis, [9][10][11][12] for which a biopsy and pathologic diagnosis is often necessary. Insulin injected into areas of amyloidosis may suffer from significantly impaired absorption.…”