Vasigh Mostafa, Mohammady Janan, Hopkins Rachel
Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA.
Internal Medicine, Tehran University of Medical Sciences, Tehran, IRN.
Cureus. 2020 Oct 10;12(10):e10886. doi: 10.7759/cureus.10886.
Insulin edema is a rare complication of insulin therapy which has been described in known or newly diagnosed people with diabetes, following initiation or intensification of insulin treatment. Here we present a 63-year-old man with complaints of weight gain, shortness of breath, and lower extremity edema starting two weeks after the change of his insulin pump to the hybrid closed-loop insulin pump system and substitution of U-100 aspart insulin with U-500 regular insulin. Laboratory studies, imaging, and electrocardiogram (EKG) were performed to evaluate the cause of acute edema and were all normal. Hemoglobin A1C showed remarkable improvement after the pump change and the insulin pump download showed a significant increase in the amount of total daily insulin administered. With the exclusion of other causes of acute edema, the patient was diagnosed with insulin edema. He was started on spironolactone 50 mg/daily and showed a desirable improvement of edema on follow-up. This case shows that although the use of the hybrid insulin-pump system helps to obtain better control of diabetes in many patients, the rapid improvement in glycemic control may precipitate the development of insulin edema. Furthermore, the use of high concentration insulin in insulin pumps is off-label and their use might increase the rate of complications of insulin therapy including insulin edema.
胰岛素水肿是胰岛素治疗的一种罕见并发症，在已知或新诊断的糖尿病患者中，于胰岛素治疗开始或强化后出现。本文报告一名63岁男性，在将胰岛素泵更换为混合闭环胰岛素泵系统并将U-100门冬胰岛素换为U-500常规胰岛素两周后，出现体重增加、呼吸急促和下肢水肿的症状。进行了实验室检查、影像学检查和心电图（EKG）检查以评估急性水肿的原因，结果均正常。更换泵后糖化血红蛋白（HbA1c）显著改善，胰岛素泵下载数据显示每日胰岛素总给药量显著增加。排除急性水肿的其他原因后，该患者被诊断为胰岛素水肿。开始给予螺内酯50mg/日治疗，随访时水肿情况得到明显改善。该病例表明，尽管混合胰岛素泵系统有助于许多患者更好地控制糖尿病，但血糖控制的快速改善可能会促使胰岛素水肿的发生。此外，胰岛素泵中使用高浓度胰岛素属于超说明书用药，其使用可能会增加包括胰岛素水肿在内的胰岛素治疗并发症的发生率。
