Asian Journal of Research and Reports in Endocrinology

Insulin Mediated Lipohypertrophy

Manda Anusha *

Department of Pharmacy Practice, St. Pauls College of Pharmacy, Hyderabad, Telanagana, India.

Jannapala Anusha

Department of Pharmacy Practice, St. Pauls College of Pharmacy, Hyderabad, Telanagana, India.

Adiba Nousheen

Department of Pharmacy Practice, St. Pauls College of Pharmacy, Hyderabad, Telanagana, India.

Enara Bawani

Department of Pharmacy Practice, St. Pauls College of Pharmacy, Hyderabad, Telanagana, India.

Sangareddy Jayanth Kumar

Department of Pharmacy Practice, St. Pauls College of Pharmacy, Hyderabad, Telanagana, India.

*Author to whom correspondence should be addressed.

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Abstract

Insulin is used to treat diabetes Type I and II. This article explains how a lipohypertrophy is caused by the insulin and explains the precautions that should be taken during the administration of insulin. Lipohypertrophy (LH) is a typical side effect of insulin therapy in subcutaneous tissue. Several injections at the same place result in this problem. A potential underlying mechanism of lipohypertrophy is the production of insulin antibodies. Recognizing and effectively managing these problems are crucial. In order to detect mild forms of lipohypertrophy, every patient should have their lips thoroughly evaluated for the condition during a diabetes clinic evaluation. The best current preventative and therapeutic approaches for lipohypertrophy are non-reuse of needles and rotation of injection sites with each injection. Education for both doctors and patients on recognising and treating lipohypertrophy is advisable.

Keywords: Diabetes, insulin, lipohypertrophy

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References

Cefalu WT. Insulin resistance: Cellular and clinical concepts. Experimental biology and medicine. 2001;226(1):13-26.

Pérez A, Ramos A, Carreras G. Insulin therapy in Hospitalized patients. American Journal of Therapeutics; 2020.

Smith MJ, Simmons KM, Cambier JCB. Cells in type 1 diabetes mellitus and diabetic kidney disease. Nature Reviews Nephrology. 2017;13(11): 712-20.

Donner T, Muñoz M. Update on insulin therapy for type 2 diabetes. The Journal of Clinical Endocrinology and Metabolism; 2012.

Howard-Thompson A, Khan M, Jones M, George CM. Type 2 diabetes mellitus: Outpatient insulin management. American family physician; 2018.

Unger J, Parkin C. Hypoglycemia in insulin-treated diabetes: A case for increased vigilance. Postgraduate Medicine; 2011.

Radermecker RP, Piérard GE, Scheen AJ. Lipodystrophy reactions to insulin: Effects of continuous insulin infusion and new

insulin analogs. American Journal of

Clinical Dermatology; 2007.

Richardson T, Kerr D. “Skin-related complications of insulin therapy.” American Journal of Clinical Dermatology. 2003;4(10):661–667.

Bertuzzi F, Meneghini E, Bruschi E, Luzi L, Nichelatti M, O Epis. “Ultrasound characterization of insulin induced lipohypertrophy in type 1 diabetes mellitus.” Journal of Endocrinological Investigation. 2017;40(10):1107–1113.

Raile K, Noelle V, Landgraf R, Schwarz H. “Insulin antibodies are associated with lipoatrophy but also with lipohypertrophy in children and adolescents with type 1 diabetes.” Experimental and Clinical Endocrinology and Diabetes. 2001;109(08): 393–396.

Reeves WG, Allen BR, Tattersall RB. Insulin-induced lipoatrophy: Evidence for an Immunepathogenesis. BMJ.1980; 280:1500-03.

Raile K, Noelle V, Landgraf R. Insulin antibodies are associated with lipoatrophy but also with lipohypertrophy in children and adolescents with type 1 diabetes. Exp Clin Endocrinol Diabetes. 2001;109:393-6.

Frid A, Hirsch L, Gaspar R. New injection recommendations for patients with diabetes. Diabetes Metab. 2010;36 (2):3-18.

Roper NA, Bilous RW. Resolution of lipohypertrophy following change of short-acting insulin to insulin lispro (Humalog). Diabet Med. 1998;15:1063-4.

Kumar O, Miller L, Mehtalia S. Use of dexamethasone in treatment of insulin lipoatrophy. Diabetes. 1977;26:296-9.

Richardson T, Kerr D. Skin related complications of insulin therapy: Epidemiology and emerging management strategies. Am J Clin Dermatol. 2003;4:661-7.

McNally PG, Jowett NI, Kurinczuk JJ, Peck RW, Hearnshaw JR. Lipohypertrophy and lipoatrophy complicating treatment with highly purified bovine and porcine insulin's. Postgrad Med J. 1988;64:850-3.

Kordonouri O, Lauterborn R, Deiss D. Lipohypertrophy in young patients with type 1 diabetes. Diabetes Care. 2002;25:634.

Vardar B, Kizilci S. Incidence of lipohypertrophy in diabetic patients and a study of influencing factors. Diabetes Res Clin Pract . 2007;77:231-6.

Schiazza L, Occella C, Bleidl D, Rampini E. Insulin lipohypertrophy j am acad dermatol. 1990;22:148-9.

Hauner H, Stockhamp B, Haastert B. Prevalence of lipohypertrophy in insulin treated patients and predisposing factors. Exp Clin Endocrinol Diabetes. 1996;104:106-10.

Concurrence of lipoatrophy and lipohypertrophy in children with type 1 diabetes using recombinant human insulin Arijit Singha; Rana Bhattarcharjee; Sujoy Ghosh; Sumit Kumar Chakrabarti; Arjun Baidya; Subhankar Chowdhury. 2016; 34(1):51–53

Dar IH, Dar SH, Wani S. Insulin lipohypertrophy: A non-fatal dermatological complication of diabetes mellitus reflecting poor glycemic control. Saudi Journal of Medicine and Medical Sciences. 2013;1(2):106.

Sharma DA. Case of regression of insulin lipohypertrophy with correct injection technique. Journal of Diabetology. 2022;13(2):184.

Barola A, Tiwari P, Bhansali A. Insulin-mediated lipohypertrophy: An uncommon cause of diabetic ketoacidosis. Case Reports; 2017.

Fujikura J, Fujimoto M, Yasue S, Noguchi M, Masuzaki H, Hosoda K, Tachibana T, Sugihara H, Nakao K. Insulin-induced lipohypertrophy: Report of a case with histopathology. Endocrine Journal. 2005;52(5):623-8.

Chowdhury TA, Escudier V. Poor glycaemic control caused by insulin induced lipohypertrophy. Bmj. 2003; 327(7411):383-4.

De Villiers FP. Lipohypertrophy—a complication of insulin injections. Journal of Endocrinology, Metabolism and Diabetes of South Africa. 2006;11(2):64-6.

Raile K, Noelle V, Landgraf R, Schwarz HP. Insulin antibodies are associated with lipoatrophy but also with lipohypertrophy in children and adolescents with type 1 diabetes. Exp Clin Endocrinol Diabetes.

;109:393-6.

Young RJ, Hannan WI, Frier BM, Steel JM, Duncan JP. Diabetic lipohypertrophy delays insulin absorption. Diabetes Care. 1984;7:479-80.

UK Prospective Diabetes Study {UKPDS} Group. Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complica-tions in patients with type 2 diabetes (UKPDS 33). Lancet. 1998; 352: 837-53.

Barola A, Tiwari P, Bhansali A, Grover S, Dayal D. Insulin-related lipohypertrophy: lipogenic action or tissue trauma?. Frontiers in Endocrinology. 2018;9:638.