What Is The Diagnosis?
Answer: Lipodystrophy at insulin injection sites
Rarely, a disfiguring atrophy of subcutaneous fatty tissue occurs at the site of insulin injection. Although the cause of this complication is obscure, it seems to represent a form of immune reaction, particularly because it occurs predominantly in females and is associated with lymphocyte infiltration in the lipoatrophic area. This complication has become even less common because of the development of highly purified insulin preparations of neutral pH. Injection of highly purified preparations of insulin directly into the atrophic area often results in restoration of normal contours.
Lipohypertrophy, on the other hand, is not a consequence of immune responses; rather, it seems to be due to the pharmacologic effects of depositing insulin in the same location repeatedly. It is prevented by rotation of injection sites. There is a case report of a male patient who had intractable lipohypertrophy (fatty infiltration of injection site) with human insulin but no longer had the problem when he switched to insulin lispro.
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