TITLE

Pathophysiology of Recombinant Human Insulin-Induced Local Lipoatrophy

AUTHOR(S)
Ximena Lopez; Castells, Mariana C.; Velazquez, Elsa F.; Ricker, Alyne; Lin, Debby A.; Mun, Edward C.; Goldfine, Allison B.
PUB. DATE
June 2007
SOURCE
Diabetes;Jun2007 Supplement 1, Vol. 56, pA158
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Insulin-induced lipoatrophy has become uncommon after the introduction of purified recombinant human insulin. It can be cosmetically devastating and the loss of subcutaneous tissue sites for insulin administration complicates therapy. We report 5 cases of local lipoatrophy associated with modified insulin analogs. Patients had type 1 diabetes and were 14-34 years of age at presentation. Local lipoatrophy was associated with use of lispro (n=3), aspart (n=2), NPH (n=1) and glargine (n=1). In 2 cases local lipoatrophy was clinically apparent with both lispro and aspart. Two of 5 patients had additional autoimmune disease including Graves Disease and hypothyroidism. No patient had measurable latex IgE antibodies. Serum protein electrophoresis, erythrocyte sedimentation rate, antinuclear antigen, rheumatoid factor, tryptase, TNF-α and complement levels C3, C4 and CH50 were all normal. All of the patients had negative human insulin IgE but modestly elevated human insulin IgG antibodies (range 11-141 µg/ml, normal <9). Allergy skin testing was performed in 4 patients and no local reaction was demonstrated to either insulin or diluent. Subcutaneous fat biopsies were available in 3 patients. Biopsies from non-affected areas were used as control. All the biopsies from affected areas showed lobular adipose tissue atrophy with focal fibrosis and a variable degree of angiocentric and lobular lymphocytic panniculitis. Eosinophils were prominent in two cases. An elevated mast cell population identified with tryptase, chloroacetate esterase (CAE) and c-kit stains, was present in perivascular and interstitial location in all cases. A variable degree of active mast cell degranulation was seen. Direct immunofluorescence for IgG, IgA, IgM, C3 and fibrin were all negative. The high number of recent cases of local lipoatrophy suggests that local allergic reactions may be more prevalent with insulin analogs. Mast cells may contribute to the destructive inflammatory process and may potentially be a target for therapeutic intervention.
ACCESSION #
25820909

 

Related Articles

  • Cotherapy with recombinant human IGF-I and insulin improves glycemic control in type 1 diabetes. Lanzetta, Paolo; Malara, Claudio; Lanzetta, P; Malara, C // Diabetes Care;Mar2000, Vol. 23 Issue 3, p436 

    Comments on the article by Thrailkill, et al, about the improvement of glycemic control in type 1 diabetes through cotherapy with recombinant human insulin-like growth factor-I and insulin. Praise given to the authors for exploring other strategies for a better treatment of type 1 diabetes;...

  • Improved Glycemic Control with Oral Recombinant Human Insulin in Patients with Type 2 Diabetes (T2DM) Inadequately Controlled on Metformin. Goldberg, Michael; Dinh, Steve; Castelli, Cristina; Majuru, Shingai; Arbit, Ehud // Diabetes;Jun2007 Supplement 1, Vol. 56, pA121 

    Oral recombinant human insulin (OI) is absorbed enterically into the portal venous system mimicking the pathway of endogenous insulin secretion and thus exerting its principal effect on hepatic glucose metabolism. Further, OI pharmacokinetics replicate the acute insulin response (AIR), deficient...

  • Chemical and Biological Characterization of Recombinant Human Insulin Produced in Transgenic Plants. Boothe, Joseph; Nykiforuk, Cory; Murray, Elizabeth; Kuhlman, Philip; Pollock, W. Brent; Goren, Joseph; Keon, Richard; Markley, Nancy; Moloney, Maurice // Diabetes;Jun2007 Supplement 1, Vol. 56, pA122 

    Insulin therapy presently remains the only available treatment for Type 1 diabetes and is invariably required in the treatment of Type 2 diabetes as the disease progresses. The vast majority of insulin used in treatment is a recombinant human form manufactured in either E. coli or Saccharomyces...

  • Insulin analogues: too much noise about small benefits. Siebenhofer-Kroitzsch, Andrea; Horvath, Karl; Plank, Johannes // CMAJ: Canadian Medical Association Journal;2/17/2009, Vol. 180 Issue 4, p369 

    The authors reflect on the research findings which demonstrate that insulin analogues are not as effective as conventional insulin in glycemic control. They cite that based on studies conventional insulin still remain effective, thus, extensive promotion for the benefit of insulin analogues are...

  • Delay in Onset of Awareness of Acute Hypoglycemia and of Restoration of Cognitive Performance During Recovery. Evans, Mark L.; Pernet, Andrew; Lomas, Jill; Jones, Jenny; Amiel, Stephanie A. // Diabetes Care;Jul2000, Vol. 23 Issue 7, p893 

    Focuses on a study which examined the time course for the onset of, and recovery from, acute hypoglycemia in healthy subjects. Information on hypoglycemia; Research design and methods; Results.

  • insulin aspart.  // Royal Society of Medicine: Medicines;2002, p305 

    The article presents information on insulin aspart, a recombinant biosynthetic human insulin analogue, which is used in diabetic treatment to maintain diabetic patients. Insulin aspart has a faster rate of onset and offset of action than soluble insulin. Administration is by injection.

  • insulin lispro.  // Royal Society of Medicine: Medicines;2002, p305 

    The article presents information on insulin lispro, a recombinant biosynthetic human insulin analogue, which is used in diabetic treatment to maintain diabetic patients. Insulin lispro is relatively short-acting. Administration is by injection.

  • Insulin: A Voice for Choice. Teuscher, Arthur // Diabetes Health;Dec2007/Jan2008, Vol. 16 Issue 6, p18 

    The article discusses the dangers of hypoglycemic unawareness in diabetics who are taking human insulin. Human insulin came into use in the 1980s as a more physiological alternative to animal insulin, but some patients however reported a sudden loss of symptoms that had previously warned them...

  • A Case of Suppurative Granuloma Induced by Insulin Injection. Tanizaki, Hideaki; Matsumura, Vumi; Tokura, Yoshiki; Miyachi, Yoshiki; Kabashim, Kenji // Acta Dermato-Venereologica;2010, Vol. 90 Issue 5, p540 

    The article presents a case study of a 76-year-old woman with diabetes mellitus presenting with multiple deep-seated, slightly pruritic, symmetrical skin nodules on the flanks and thighs. She claimed that the lesion appeared two-three days after insulin injections. A skin biopsy of an...

Share

Read the Article

Courtesy of

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics