Abstract

Lipodystrophy with an uncommon clinical presentation in a patient with type 2 diabetes on insulin therapy

Author(s): Chaima Jemai*, Achwak Mehrez, Yosra Htira, Takwa Moussa, Zohra Hadj Ali, Salma Mohsen, Olfa lajili, Hana Ben Jemaa, Imen Hedfi, Faika Ben Mami

Introduction: We report the case of a patient with type 2 diabetes on insulin therapy who had a lipodystrophy with uncommon clinical presentation.

Case presentation: This was the case of a 67-years-old female with type 2 diabetes hospitalized for exploration and management of severe and recurrent hypoglycemia. Her diabetes was evolving since the age of 40 years and was complicated by a minimal retinopathy. She was on premixed human insulin, administered through insulin syringe for the last 17 years. She presented a history of well-controlled diabetes until 5 months back when she started to present a fluctuating blood glucose concentration, with episodes of unpredictable hypoglycemia occurring in variable times, with values inferior to 0.3 g/l associated to 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 up to one week for economic reasons and not frequently rotating insulin injections’ sites. The patient finds less painful injection in lipohypertrophic area and she continued to inject insulin into that zone leading to its progressive enlargement. The therapeutic management consisted in switching the patient to insulin analogues and the resumption of the education concerning the correct injection techniques.

Conclusion: Insulin injection technique continues to be suboptimal in many insulin treated patients and our case emphasizes the need for improved awareness and education.