Cutaneous amyloidosis at insulin injection site
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Cutaneous amyloidosis at insulin injection site A recent Drug Safety Update from the Medicines and Healthcare products Regulatory Agency (MHRA) reminded healthcare professionals that cutaneous amyloidosis at the injection site has been reported in patients using insulin, and that rotation of injection sites within the same body region should be reinforced. Deposits of amyloid protein under the skin are composed of insulin fibrils, likely to be caused by accumulation when the injection sites are repeatedly used. This may interfere with insulin absorption and therefore result in poor glycaemic control. A European review concluded that there was a clear causal relationship between cutaneous amyloidosis and insulin use, although occurrence is rare. There is potential for under-reporting, and misdiagnosis as lipohypertrophy. Up to July 2020, the MHRA had received 2 reports of cutaneous amyloidosis in patients receiving insulin. For patients with cutaneous amyloidosis, there is a risk of hypoglycaemia when the injection site is changed to an unaffected area. Patients should be advised to carefully monitor blood glucose, and consider dose adjustment if required. The Summaries of Product Characteristics and Patient Information Leaflets for all insulins and insulin-containing products are being updated to include the risk of cutaneous amyloidosis. Any adverse reactions should be reported to the MHRA. Medicines and Healthcare products Regulatory Agency. Insulins (all types): risk of cutaneous amyloidosis at injection site. Drug Safety Update 14: 10-12, No. 2, Sep 2020. 803506575 Available from: URL: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/920770/Sept-2020-DSU-PDF.pdf
0114-9954/20/1825-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 10 Oct 2020 No. 1825
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