Lipohypertrophy and lipoatrophy complicating treatment with highly purified bovine and porcine insulins

Abstract

Summary Lipoatrophy and lipohypertrophy were the most frequently reported local complications of conventional insulin therapy. Early reports following the introduction of highly purified insulins suggested a reduction in the frequency of lipohypertrophy and lipoatrophy. Since highly purified insulins have been in common usage for 10 years, the present frequency of these complications was assessed in a study of 281 insulin treated diabetics. Lipohypertrophy was recorded in 76 (27.1%) patients including 3 with associated lipoatrophy. Lipoatrophy was found in 7 (2.5%) cases (3 porcine and 4 bovine insulin treated), 4 of which had only ever used highly purified insulins. Despite the introduction of highly purified insulins, lipohypertrophy and lipoatrophy remain prevalent in insulin treated patients. This common complication may be limited by routinely inspecting injection sites.

Evaluation of Skin and Subcutaneous Adipose Tissue Thickness for Optimal Insulin Injection

“…Lipoatrophia and hypertrophy are well-known complications of insulin treatment [17]. However, these do not represent a common disorder of skin and subcutaneous adipose tissues but are rather local complications.…”

Resolution of lipohypertrophy following change of short-acting insulin to insulin lispro (Humalog®)

“…Improvements in the purity of insulin preparations and the widespread use of recombinant human insulin have dramatically reduced the prevalence of lipoatrophy, but the prevalence of lipohypertrophy has been little affected, with reported incidences of up to 30 %. [1][2][3] Rotation of injection sites can reduce the frequency of lipohypertrophy but does not abolish it. The occurrence of this complication has cosmetic importance and can affect insulin absorption 4,5 and, by implication, glycaemic control.…”

Human Insulin–Induced Lipoatrophy

“…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-␣, 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)(3)(4).…”