Insulins

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Insulin-derived amyloidosis at injection site: 2 case reports In a case report, two men aged 81 years and 87 years were described who developed insulin-derived amyloidosis at the injection site during treatment with insulin aspart, insulin detemir, insulin glargine or insulin lispro for type II diabetes mellitus [dosages and outcomes not stated]. Case 1: An 81-year-old man, who had type II diabetes mellitus for 29 years, was hospitalised due to poor glycaemic control. He had been receiving multiple SC injections of insulin lispro and insulin glargine daily for 26 years. On admission, the total daily dose of SC insulin was 46 units/day with a glycated haemoglobin level of 9.1%. Physical examination showed bilateral lipohypertrophy without palpation at injection sites of insulins on his lower abdomen. His blood glucose level improved after changing the injection site. Therefore, the insulin dose was decreased to 24 unit/day. To determine the variation in insulin absorption, he received injection of SC insulin lispro 6 units at previous injection site and at normal injection site prior to breakfast on different days. His insulin absorption and eventually serum insulin concentrations at previous injection site were significantly lower compared to normal injection site. This led to poor glycaemic control requiring increased insulin dose. On the basis of lab tests, MRI of the injection sites and histopathology findings, he was diagnosed with insulin-derived amyloidosis. Case 2: An 87-year-old man, who had type II diabetes mellitus for 16 years, was hospitalised due to hypoglycaemic coma. He had been receiving multiple SC injections of insulin detemir and insulin aspart for 16 years. The daily dose of SC insulin was 36 units/day with glycated haemoglobin of 8.3%. Physical examination showed a soft swelling on his right lower abdomen without palpation. The insulin dose was decreased to 21 units/day with good glycemic control after changing the injection sites. On the basis of MRI of the injection sites, ultrasonography and histopathology findings, he was diagnosed with insulin-derived amyloidosis [outcomes not stated]. Nagase T, et al. Insulin-derived amyloidosis without a palpable mass at the insulin injection site: A report of two cases. Journal of Diabetes Investigation 11: 1002-1005, No. 803499051 4, Jul 2020. Available from: URL: http://doi.org/10.1111/jdi.13199

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Reactions 5 Sep 2020 No. 1820