Lipoatrophy insulin

Lipoatrophy- Lipoatrophy is the breakdown of adipose tissue at the insulin injection site causing a depression in the skin. 

Lipodystrophy Rarely, administration of insulin subcutaneously can result in lipoatrophy (depression in the skin) or lipohypertrophy (enlargement or thickening of tissue). 

Lipodystrophy, lipoatrophy, or lipohypcrtrophy can be a consequence of chronic local insulin reactions that can be elicited by less pure as well as by highly purified preparations (140), but such reactions can also develop at sites distant to the injection. 

Lipoatrophy, although rare, has been reported in patients using both regular and lispro insulin in CSII pumps (198,199). 

Jones GR, Statham B, Owens DR, Jones MK, Hayes TM. Lipoatrophy and monocomponent porcine insulin. BMJ (Clin Res Ed) 1981 282(6259) 190. 

Griffin ME, Feder A, Tamborlane WV. Lipoatrophy associated with lispro in insulin pump therapy. Diabetes Care 2001 24 174. 

Lipoatrophy due to insulin lispro during pump therapy has been reported before [SEDA-25,510 SEDA-27,449]. 

A 35-year-old woman transferred from regular insulin to insulin lispro, as she had developed unawareness of hypoglycemia (32). After 23 months she developed a circumscribed area of lipoatrophy about 3 cm in diameter at an injection site on the right thigh. Her antiinsulin antibodies were high (50%). Six months later... 

Two cases of lipoatrophy induced by insulin lispro during continuous subcutaneous insulin infusion have been reported (28). 

A 51-year-old woman started to use continuous subcutaneous insulin and after 2 years the insulin was changed to insulin lispro. She developed lipoatrophy in the abdomen and buttocks 1 year later and there was an increase in the time before the bolus started to peak. Buffered regular human insulin stopped progression of the lipoatrophy. 

Insulin lispro can cause lipoatrophy, but it was less extensive in a case in which it had occurred with regular insulin, perhaps because of the greater solubility of insulin lispro. 

Ampudia-Blasco FJ, Hasbum B, Carmena R. A new case of lipoatrophy with lispro insulin in insulin pump therapy is there any insulin preparation free of complications Diabetes Care 2003 26(3) 953-4. 

Arranz AA, Andia V, Lopez-Guzman A. A case of lipoatrophy with lispro insulin without insulin pump therapy. Diabetes Care 2004 27 625-6. 

Dyslipidemia is a common accompaniment of the lipodystrophy syndrome observed in HIV-infected patients. This syndrome presents as a combination of peripheral lipoatrophy and the metabolic syndrome (central adiposity, insulin resistance, and dyslipidemia). The term lipodystrophy syndrome was first used in two case reports to describe a clinical picture of subcutaneous fat wasting in the face and limbs of HIV infected patients treated with indinavir, reminiscent of the rare congenital lipodystrophy syndromes (138,139). In addition, benign symmetric lipomatoses on the trunk and neck were described. A systematic study of this syndrome in the Australian HIV cohort showed co-existence of peripheral lipoatrophy with abdominal visceral obesity, dyslipidemia, and insulin resistance in HIV-infected patients with or without treatment with protease inhibitors (140). 

Yamauchi T, Kamon J, Waki H, et al. The fat-derived hormone adiponectin reverses insulin resistance associated with both lipoatrophy and obesity. Nat Med 2001 7 941-946. 

Vinson, C., Reitman, M. L., Kagechika, H., Shudo, K., Yoda, M., Nakano, Y., Tobe, K., Nagai, R., Kimura, S., Tomita, M., Froguel, P., and Kadowaki, T. 2001. The fat-derived hormone adiponectin reverses insulin resistance associated with both lipoatrophy and obesity. Nat. Med,., 7, 941-946. 

Disadvantages are poor absorption in peripheral circulatory failure. Repeated injections at one site can cause lipoatrophy, resulting in erratic absorption (see Insulin). 

Other adverse reactions to insulin are lipodystrophy (atrophy or hypertrophy) at the injection sites (rare with purified pork and human insulin), after they have been used repeatedly. These are unsightly, but otherwise harmless. The site should not be used further, for absorption can be erratic, but the patient may be tempted to continue if local anaesthesia has developed, as it sometimes does. Lipoatrophy is probably allergic and lipohypertrophy is due to a local metabolic action of insulin. Local allergy also is marrifested as itching or painful red lumps. 

Rare complications are lipoatrophy or hjrpertrophy and insulin edema. Insulin has to be given by injection, with pumps or specific devices for intensive therapy, which all generate specific problems. Other ways of administrating insulin are still experimental. 

For therapy of local lumps, extravasation, etc., one should first seek to improve the injection technique. Substitution with highly purified insulin is recommended. Injection with purified insulin into the affected area may speed up resorption of the lumps. Lipodystrophy or lipoatrophy improve after switching to highly purified human or insulin lispro. Lipohypertrophy, on the other hand, often fails to respond to changes in the insulin regimen (130). Varying the injection site may help, but differences in absorption rate then have to be taken into account. 

Insulin, administered subcutaneously, may cause either lipoatrophy or lipohypertrophy. Lipoatrophy is the breakdown of adipose tissue at the insulin injection site causing a depression in the skin at the injection site and occasionally at distant sites also. It may be the result of an immune response or the use of less than pure insulin. Some findings suggest that total lipodystrophy syndrome results from the inflammatory destructive process of adipose tissue (Yanagawa et al., 1990). Injection of human or purified porcine insulin into the site over a 2-4-week period may result in subcutaneous fat accumulation. 

Before purified human insulins were available, lipoatrophy occurred in about 25% of insulin-treated patients. Improvement or resolution of lesions has been noted in most patients after changing to purified porcine insulin. 

Lipoatrophy and lipohypertrophy were the most frequently reported local complications of conventional insulin therapy. Early reports after the introduction of highly purified insulins suggested a reduction in the... 

Both pork and human insulin are definitively less immunogenic than beef insulin, producing fewer circulating insulin antibodies, but several studies have indicated no detectable change in antibody concentrations on switching from pork to human insulin or vice versa. Antibodies cause lipoatrophy and are responsible for the substantial insulin resistance seen in some patients, but both events are rare now that purified pork insulin is in common use. Interest has recently been revived in the possible contribution of antibodies in modifying metabolic control. In the short term and under hospital conditions, they are known to prolong the intravenous half-life of injected insulin and to delay the appearance in the circulation of a subcutaneously administered bolus dose. 

The two forms of lipodystrophy, though less common today in people with diabetes, still occur. Lipohypertrophy is caused by many injections into the same injection site. Due to insulin s anabolic actions, a raised fat mass is present at the injection site with resultant variable insulin absorption. Lipoatrophy, in contrast, is thought to be due to insulin antibodies, with destruction of fat at the site of injection. Injection away from the site with more purified insuhn is recommended, though several reports of lipoatrophy with lispro have been reported. 

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