Lipoatrophy associated with rapid-acting insulin analogues in young patients with type 1 diabetes mellitus.

Lipoatrophy as a cutaneous complication of insulin therapy has been practically forgotten since the introduction of recombinant human insulin. Here we present two cases of marked lipoatrophy associated with rapid-acting insulin analogues (aspart and lispro) administered with continuous subcutaneous insulin infusion or multiple daily injections in a toddler and a young woman with type 1 diabetes mellitus. The exact mechanisms related to the development of localized lipoatrophy in the insulin injection area are unknown. In cases of lipoatrophy the beneficial therapeutic approach is to change the insulin molecule. With switching from one insulin analogue to another administered in insulin pump and changing the sites of insulin injections no progression of the lipoatrophic lesions was observed. Unfortunately, only decrease but no total regression of the formed lesions was achieved and future studies are needed to establish the method of treatment of localized lipoatrophy in children treated with continuous subcutaneous insulin infusion.