The eye does not see what the mind does not know

Abstract

Case report A 64 year old gentleman with a 15 year history of type 2 diabetes presented to us with extremely poor glycaemic control in spite of being on escalating insulin doses (100 Units/day). Multiple medical consultations over the preceding six months resulted in further addition of oral agents. His fasting glucose was 22 mmol/L, postprandial glucose of 29 mmol/L with glycosylated haemoglobin of 13.5%. There was no reason to suspect noncompliance. Clinical examination revealed a large area of lipohypertrophy over the right arm (Figure 1). On further questioning, the patient admitted to injecting insulin at the same site for the past 3 years with no rotation of sites. He was educated about injection site rotation and subsequently, glycaemic control improved dramatically over the next few weeks. On a recent follow-up, his fasting glucose was 5.5 mmol/L with a postprandial glucose of 8.2 mmol/L.