Lipodystrophy with insulin injection

Adverse effects observed with insulin Note lipodystrophy is a local atrophy or hypertrophy of subcutaneous fatty tissue at the site of injections. 

Infrequent Somogyi effect (rebound hyperglycemia) with chronically excessive insulin doses. Systemic allergic reaction (rash, angioedema, anaphylaxis), lipodystrophy (depression at injection site due to breakdown of adipose tissue), lipohypertrophy (accumulation of SC tissue at injection... 

Somogyi effect, including rebound hyperglycemia with chronically excessive insulin dosages systemicallergic reaction, marked by rash, angioedema, and anaphylaxis lipodystrophy or depression at injection site due to breakdown of adipose tissue lipo-hypertrophy or accumulation of subcutaneous tissue at injection site due to inadequate site rotation Rare... 

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 lipoa-trophy 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 (161). Varying the injection site may help, but differences in absorption rate then have to be taken into account. 

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. 

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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