Insulin-induzierte Ödeme bei Adoleszenten mit Diabetes mellitus Typ I

Abstract

Two girls (aged 14 and 16 years) with type I diabetes were hospitalized with blood sugar levels of 394 and 319 mg/dl as well as HbA1 levels of 14.2 and 14.1%, respectively. In the first case it was the first sign of diabetes, in the other it was the result of a metabolic dysfunction with an injection abscess after ten years of the disease. After an initial substitution with regular insulin (subcutaneously in Case 1 [1.5-1.7 IU/kg daily for 3 days; in Case 2, continuous i.v. infusion [1.3 IU/kg daily] for 58 hours, followed by injections of appropriate mixtures of short and long-acting insulin) serum glucose levels were nearly always within normal range from the third day onward. Within 6 days of normal glucose levels being established hard pitting oedema, especially of the legs, developed in both girls, associated with a weight gain of 6.1 and 7.0 kg, respectively. Renal, hepatic and cardiovascular disease having been excluded the diagnosis of insulin-induced oedema was made. Within a further two weeks the oedema had disappeared without any specific treatment.

Insulin‐induced oedema in children and adolescents

“…Although insulin‐induced oedema has been observed equally in adult men and women (1), there is a clear female predominance in the younger ages (Table 1). Three of the reported children were newly diagnosed, as was our patient and the remaining were poorly controlled 3–7 . Oedema was generalised in eight of the children and confined to the lower extremities in one 7 .…”

“…In six of the nine reported children in the literature, oedema resolved spontaneously within 7–20 days and did not recur whereas in one child oedema resolved after discontinuation of insulin 5–7 . A child received frusemide alone and another child received frusemide combined with ephedrine, 2 and oedema resolved completely within 1 month in both children.…”

“…Three of the reported children were newly diagnosed, as was our patient and the remaining were poorly controlled. [3][4][5][6][7] Oedema was generalised in eight of the children and confined to the lower extremities in one. 7 Reduced serum albumin was found in two cases.…”

“…The first paediatric report dates from 1979 3 and since then nine cases have been described. 2,[4][5][6][7] We describe a case in a newly diagnosed adolescent girl and review the literature for children presented with this unusual complication.…”