Endocrine Abstracts

Introduction: Lipoatrophy is a rare cutaneous complication in diabetes that presents with localized subcutaneous fat atrophy at the insulin injection site. We report a case of a 62-year-old man type 1 diabetic with lipoatrophy lesions on the thighs.

Case report: A 62-year-old male, with clinical history of basedow’s disease, He was diagnosed type 1 diabetes (T1D) when he was 19 years old, treated with premixed human insulin for the last 4 years.His weight was 68 kg and his body mass index was 21 kg/m2, he developed subcutaneous lipoatrophy around the insulin injection site at the thighs. The rest of the physical examination was normal.The results of blood testing were: K⁺4.1 mEq/l, Na⁺139 mEq/l, Hb1Ac 8.9%, cholesterol 157 mg/dl, triglycerides 108 mg/dl, liver and kidney functions were normal.The type of insulin was changed to insulin analogs (aspart and glargine insulin) and the injection site was changed to the abdomen.

Discussion: Lipoatrophy, is clinically characterized by visible cutaneous depression at the injection site. With the arrival of more purified forms of insulin it has become an extremely rare complication of insulin therapy. It is more than a cosmetic problem, because of the variability of insulin absorption of insulin and therefore the glycemic controlLipoatrophy is due to mechanical trauma from repeat injections. Immune etiologies have also been suggested, furthermore, the authors stated that lipoatrophy is found more frequently in patients with other autoimmune diseases, our patient has Basedow’s diseaseAvoiding injections in the lipoatrophy sites and changing the insulin needle daily help to resolve lipoatrophy. Local treatment with sodium cromolyn, low- dose oral, or subcutaneous coadministration of corticosteroid are some therapeutic options used in some studies.

Conclusion: Lipoatrophy although rare can still occur even with the use of technologically advanced newer insulin preparations. This complication of insulin therapy may be limited by regularly inspecting and changing the injection sites.