Insulin-induced edema: an unusual complication in a patient with diabetic ketosis.

The insulin-induced edema is a rare complication of insulin therapy. Two mechanisms are known, the sodium and water retention and vasoactive mediator's release. We report the case of a 32 years-old patient, with a history of diabetes for one month treated with metformin. He was hospitalized for diabetic ketosis and developed lower legs edema and scrotum edema, few hours after the insulin injections. Biologic tests showed hypoprotidemia without proteinuria and hyponatremia. The abdominal ultrasound showed a liver steatosis. Chest radiography was normal. Transthoracic echocardiography showed a moderate pericardial effusion. Edema resolved spontaneously one month later. Protidemia and natremia were normalized. The natural history of insulin-induced oedema was observed in our patient and the accountability of insulin is likely, but invetstigations are often needed to eliminate other causes of edemas.