Vasigh Mostafa, Hopkins Rachel
Department of Medicine, State University of New York Upstate Medical University, Syracuse, USA.
Department of Medicine, Division of Endocrinology, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA.
Clin Diabetes Endocrinol. 2022 Sep 30;8(1):6. doi: 10.1186/s40842-022-00143-0.
Insulin edema is a rare complication which can present after initiation or intensification of insulin therapy in people with diabetes. Initiation of closed-loop hybrid insulin pump therapy can result in rapid improvement in glycemic control for people with diabetes. We present a case in which transition to a closed-loop hybrid insulin pump system, followed by significant improvement in glycemic control, led to development of insulin edema in a person with type 1 diabetes.
We present a 51-year-old woman with type 1 diabetes of 16 years duration, on insulin pump therapy for more than 10 years, who presented for follow-up 7 weeks after transitioning to a hybrid closed-loop insulin pump system with continuous glucose monitoring (CGM). She complained of weight gain and bilateral lower extremity edema which had started two weeks after the change in pump modality. Laboratory studies and echocardiogram did not reveal any etiology of the acute edema. HbA1c was 3.3% lower than the previous measurement 15 weeks earlier, and there was a significant increase in the daily total insulin dose. With exclusion of other causes of acute edema, the patient was diagnosed with insulin edema and started on hydrochlorothiazide. On follow up, her lower extremity edema significantly improved although her weight did not return to baseline.
To our knowledge, this is the first case of insulin edema reported in a person with type 1 diabetes using CGM and a hybrid closed-loop insulin pump system. The increase in total daily insulin dose, rapid improvement of glycemic control, and lack of hypoglycemic episodes were important factors to consider in evaluation of this case. Use of hybrid closed-loop systems can help achieve rapid improvement in glycemic control in people with diabetes. This case suggests that consideration should be given to adjusting initial blood glucose targets when starting these remarkable new technologies in people with baseline poor glycemic control.
胰岛素性水肿是一种罕见的并发症，可在糖尿病患者开始胰岛素治疗或强化治疗后出现。启动闭环混合胰岛素泵治疗可使糖尿病患者的血糖控制迅速改善。我们报告一例1型糖尿病患者，在转换为闭环混合胰岛素泵系统后血糖控制显著改善，但随后发生了胰岛素性水肿。
我们报告一名51岁、患1型糖尿病16年的女性，接受胰岛素泵治疗超过10年，在转换为带有持续葡萄糖监测（CGM）的混合闭环胰岛素泵系统7周后前来随访。她抱怨体重增加和双侧下肢水肿，这些症状在泵模式改变两周后开始出现。实验室检查和超声心动图未发现急性水肿的任何病因。糖化血红蛋白（HbA1c）比15周前的上次测量值低3.3%，每日胰岛素总剂量显著增加。排除急性水肿的其他原因后，患者被诊断为胰岛素性水肿，并开始服用氢氯噻嗪。随访时，她的下肢水肿明显改善，尽管体重未恢复到基线水平。
据我们所知，这是首例使用CGM和混合闭环胰岛素泵系统的1型糖尿病患者发生胰岛素性水肿的病例。每日胰岛素总剂量增加、血糖控制迅速改善以及无低血糖发作是评估该病例时需要考虑的重要因素。使用混合闭环系统有助于糖尿病患者迅速改善血糖控制。该病例表明，在血糖控制基线较差的患者中开始使用这些卓越的新技术时，应考虑调整初始血糖目标。
