ECE2023 Eposter Presentations Diabetes, Obesity, Metabolism and Nutrition (355 abstracts)
New indication for long-acting second-generation basalinsulin analog?
Mouna Elleuch 1 , Cyrine Chehaider 1 , Maalej Souhir 1 , Nabil Lachiheb 1 , Dhoha Ben Salah 1 , Rim Atheymen 2 , Nadia Charfi 1 , Mouna Mnif 1 , Fatma Mnif 1 , Abderrahmen Masmoudi 3 , Naourez Gouiaa 4 , Zouhair Sahnoun 2 , Faten Haj Kacem Akid 1 & Mohamed Abid 1
1CHU Hedi Chaker, Endocrinology, Sfax, Tunisia; 2Medicine of Sfax, Pharmacology, Sfax, Tunisia; 3CHU Hedi Chaker, Dermatology, Sfax, Tunisia; 4CHU Habib Bourguiba, Anatomic Pathology, Sfax, Tunisia.
Introduction: Although skin reactions relating to insulin injection have decreased since the prescription of human insulin and the use of highly purified insulin, they are still described in the literature. They can lead to significant problems with glycemic control. The challenge is to recognize the type of reaction that is occurring and identify the type of insulin formulation that avoids these reactions.
Case-report: A 64-year-old patient, with type 2 diabetes for 24 years on premixed human insulin for 10 years, presented with pruritic erythematous lesions at insulin injection sites that appear few hours after the injection and persist for a few days. They improved under topical corticosteroids. IgG-mediated delayed hypersensitivity (type III hypersensitivity) was suspected. The reaction was induced bythe different formulations of insulin and we could not recognize whether the insulin or an excipient was incriminated. We eliminated an allergy to protamine, metacresol and zinc as well as a dermographism. This left us questioning the diagnosis of allergic reaction and we resorted to a skin biopsy. It showed a cutaneous panniculitis which is an inflammation of the subcutaneous fat that results from local trauma caused by both physical and chemical insults. Initially, the management wasto split the total daily dose of Insulin glargine 100 units/ml LANTUS®in two different sites at the same time. There action was less severe. Then, the use of Insulin glargine 300 units/ml TOUJEO® allowed to avoid this reaction.
Discussion and conclusion: The most frequent skin reactions relating to insulin injection are allergic. However, it is important for healthcare professionals to be mindful of cutaneous panniculitis as apossible complication of insulin injections. Very few similar case reports were published. It remains possible that it is under-recognized. The absence of reaction under the long-acting second-generation basal insulin analog TOUJEO® (Insulin glargine 300 units/ml)may be explained by the fact that this type of Insulin formulation allows continuous release of insulin from the adipose tissue. This allows to avoid the local trauma caused by the peaks of Insulin-release.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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