Insulin-induced lipoatrophy: an analysis of clinical features

Abstract

Objective To explore the clinical manifestations, pathogenesis and treatment of insulin-induced lipoatrophy. Methods Data of a case of exogenous insulin antibody syndrome (EIAS) and acquired lipoatrophy caused by insulin injection were collected and analyzed. From January 2010 to January 2018, clinical data of patients diagnosed with insulin-induced lipoatrophy in Peking Union Medical College Hospital were summarized. Results A total of 11 cases were diagnosed as insulin-induced lipoatrophy with 11 cases of lipoatrophy at the injection site, while 2 cases with present of lipoatrophy at the non-injection site. Both recombinant human insulin preparations and the insulin analog preparations were involved in lipoatrophy. It mostly occurred in 2 weeks to 3 years after the initiation of insulin injection. High titers of insulin autoantibodies (IAA) were found in 8 patients, of which 6 patients manifested with blood glucose fluctuation, hypoglycemia at night and elevated serum insulin level, which could be diagnosed as EIAS. Conclusion Both localized lipoatrophy and distant site lipoatrophy could be induced by insulin injection. High titers of IAA could lead to both EIAS and lipoatrophy which may occur at the same time. The mechanism might be attributed to autoimmune reaction triggered by insulin injection. When encountered with unexplained blood glucose fluctuations with concomitant lipoatrophy, serum insulin levels and IAA tests are strongly recommended to confirm EIAS. Key words: Insulin; Injections, subcutaneous; Insulin antibodies; Lipoatrophy; Exogenous insulin antibody syndrome