Insulin oedema

Zenda T, Murase Y, Yoshida I, Muramoto H, Okada T, Yagi K. Does the use of insulin in a patient with liver dysfunction increase water retention in the body, i.e. cause insulin oedema Em J Gastroenterol Hepatol 2003 15 545-9. 

Adamo L, ThoeUce M. Generalised insulin oedema after intensification of treatment with insulin analogues. BMJ Case Rep 2013. http // dx.doi.org/10.1136/bcr-2012-007037. 

A report of generalized oedema in one patient about 7 days after being started on insulin appeared in 1979 (Bleach et al., 1979). Further cases of fluid retention have been published (Lawrence and Dunnigan, 1979). 

All workers, with one exception [248], found that enzymes and related substances were affected by phosgene, and in vitro studies have shown it to react with a number of tissue-specific amino acids and with some hormones e.g. insulin), as well as with enzymes [731]. It has been speculated [443] that it is the decrease in available energy (via ATP) for maintaining pulmonary ionic and fluid homeostasis which contributes to the formation of oedema fluid [731]. Further work on this topic is needed for clarification. 

Treatment of DKA in children and young adolescents follows slightly different guidelines than those presented here [19]. It is recommended that insulin is given continuously intravenously (0.1 lU/kg BW/h) after initiation of fluid and electrolyte therapy in order to minimise the risk of cerebral oedema. Otherwise children are in general treated with weight-reduced doses as indicated later. 

Pioglitazone and rosiglitazone may cause fluid retention and peripheral oedema, which can worsen or cause heart failure. There is evidence that the incidence of these effects is higher when combined with insulin. The incidence of hypoglycaemia may also be increased. 

The egg-white and dextran reactions are inhibited in rats pretreated with alloxan [151, 702] but insulin restores the normal anaphylactoid response [5, 217, 218]. Tolbutamide is inactive in this latter respect, but this hypogly-caemic drug aggravates the reaction in normal rats [8, 305] possibly by releasing endogenous insulin. Insulin itself increases the rate of onset and the intensity of the oedema and also lowers the activity-threshold for egg-white and dextran in normal animals [9-11, 213, 217, 218, 514, 539, 540], but these potentiated... 

Eyes Case-report studies have showed side effects of bilateral transient myopia and secondary ACG with choroidal detachment after use of oral methazolamide (100 mg) in a 51-year-old male with non-insulin-dependent diabetes mellitus (DM) used for refractory macular oedema after 10 days of treatment and a 70-year-old male with normoten-sive glaucoma after 1 day of treatment, which recovered with discontinuation of methazolamide [7],... 

Generalised oedema is an extremely rare complication of insulin therapy. In a case report of a patient normally using insulin therapy without any immunological complication, generalised oedema developed after initiation of treatment with insulin analogues. [4 ]... 

Two less frequent types of brain oedema merit mentioning in cases of severe hypoglycaemia, due to insulin shock, oedema associated with pallor of white matter in corresponding myelin stains has been demonstrated [19]. This may find its explanation in the decrease of cerebral phospholipids demonstrated in rats subjected to experimental hypoglycaemia [20]. Brain oedema has also been observed in children afflicted with galactosaemia. In these cases, it is ascribed to osmotic action of the accumulated galactitol (dulcitol) [21,22]. 

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