Ultrasonography Improves Glycemic Control by Detecting Insulin-Derived Localized Amyloidosis

Insulin‐derived amyloidosis without a palpable mass at the insulin injection site: A report of two cases

“…Recently, ultrasonography has been shown to be useful to screen for transthyretin amyloidosis in abdominal fat tissue. Furthermore, ultrasonography is useful for detecting insulin‐derived amyloidosis. In case 2, ultrasonography of abdominal insulin injection sites showed hyperechoic streaks comparable to the MRI findings of the sites.…”

Extreme Adhesion Activity of Amyloid Fibrils Induces Subcutaneous Insulin Resistance

“…investigated insulin absorption by comparing serum insulin levels after insulin injections into insulin-derived amyloidosis sites versus injections into normal sites in four patients with diabetes and calculated that the mean insulin absorption at insulin-derived amyloidosis sites was 34% of that at normal sites, although differences in the degree of decrease occurred in each case. Variations in the degree of insulin absorption may be attributed to histopathological diversity, because the degree and distribution of amyloid deposits and fibrous tissue differ greatly case by case (25)(26)(27)(28). In addition, insulin-derived amyloidomas and lipohypertrophy can reportedly coexist in the same lesion (26).…”

“…However, severe hypoglycemia can be caused by moving the injection site to outside the amyloidoma (5,7,16,24). The reported degree of the inhibitory effect of insulin absorption by amyloidomas varies, probably because the degree and distribution of amyloid deposits differ greatly in particular cases (25)(26)(27)(28).…”

Localized Subcutaneous Insulin-Derived Amyloidosis Excised after Evaluation Using Ultrasonography in a Patient with Type 2 Diabetes Mellitus

“…Only a few previous reports of ultrasonographic findings of IDA have been found [ 9 , 10 ]. We have recently reported the feasibility of ultrasound diagnosis of IDA [ 11 ]. In addition to the ultrasound detectability and findings, we investigated insulin absorption rate, insulin dosage, and HbA1c before and after shifting the insulin injection site in 22 IDAs including this case.…”

“…There has been no report on the differential diagnosis of subcutaneous lesions by ultrasonographic findings between IDA and other subcutaneous indurations such as lipohypertrophy and allergic reaction. IDA was presented as a low echoic and elastic hard mass and the blood flow was low by an ultrasonography [ 11 ]. These findings may be useful for the differential diagnosis from lipohypertrophy or allergic reaction.…”