Jemai Chaima, Mehrez Achwak, Dhieb Nesrine, Htira Yosra, Ben Mami Faika
Department C, National Institute of Nutrition of Tunis, Tunis, Tunisia.
Department C, National Institute of Nutrition of Tunis, Tunis, TUN.
Cureus. 2024 Nov 17;16(11):e73835. doi: 10.7759/cureus.73835. eCollection 2024 Nov.
We report the case of a patient with type 2 diabetes mellitus (T2DM) on insulin therapy with a history of recurrent and severe hypoglycemia related to lipodystrophy with an uncommon clinical presentation. This was the case of a 67-year-old female with type 2 diabetes hospitalized for the exploration and management of severe and recurrent hypoglycemia. Her diabetes has been evolving since the age of 40 years and was complicated by minimal retinopathy. She was on premixed human insulin, administered through an insulin syringe for the last 17 years. She presented a history of well-controlled diabetes until five months back when she started to show a fluctuating blood glucose concentration, with episodes of unpredictable hypoglycemia occurring at variable times, with values inferior to 0.3 g/l associated with neurological features. Clinical examination revealed a swelling localized in the hypogastric region of the abdomen. It was painless, firm, not fixed to the underlying plans, without local inflammatory signs, and had appeared in the patient's preferred insulin injection site. Thus, we retained the diagnosis of insulin-induced lipohypertrophy. The patient has reported reusing needles for up to one week for economic reasons, and not frequently rotating insulin injection sites. The patient found a less painful injection in the lipohypertrophic area, and she continued to inject insulin into that zone, leading to its progressive enlargement. Therapeutic management consisted of switching the patient to insulin analogs and resuming education concerning the correct injection techniques. The insulin injection technique continues to be suboptimal in many insulin-treated patients, and our case emphasizes the need for improved awareness and education.
我们报告了一例2型糖尿病（T2DM）患者的病例，该患者接受胰岛素治疗，有与脂肪营养不良相关的反复严重低血糖病史，临床表现罕见。这是一名67岁的2型糖尿病女性患者，因严重反复低血糖的检查和治疗而住院。她的糖尿病自40岁起发病，并发轻度视网膜病变。在过去17年里，她一直使用预混人胰岛素，通过胰岛素注射器给药。在五个月前，她的血糖控制良好，但之后开始出现血糖浓度波动，在不同时间出现不可预测的低血糖发作，血糖值低于0.3g/L，并伴有神经症状。临床检查发现腹部下腹部区域有一个肿块。它无痛、质地硬、不与下方组织粘连、无局部炎症迹象，出现在患者常用的胰岛素注射部位。因此，我们诊断为胰岛素诱导的脂肪增生。患者因经济原因报告重复使用针头长达一周，且不经常更换胰岛素注射部位。患者发现在脂肪增生区域注射疼痛较轻，于是继续在该区域注射胰岛素，导致其逐渐增大。治疗措施包括将患者改用胰岛素类似物，并重新开展正确注射技术的教育。在许多接受胰岛素治疗的患者中，胰岛素注射技术仍然不理想，我们的病例强调了提高认识和加强教育的必要性。
