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Am J Med. 2014 May;127(5):450-4. doi: 10.1016/j.amjmed.2013.10.029. Epub 2014 Jan 21.

Insulin-derived amyloidosis and poor glycemic control: a case series.

Author information

  • 1Department of Metabolism and Endocrinology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan. Electronic address: tnagase@tokyo-med.ac.jp.
  • 2Department of Pathology, National Defense Medical College, Tokorozawa, Saitama, Japan.
  • 3Department of Metabolism and Endocrinology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.
  • 4Department of Radiology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.
  • 5Department of Plastic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.
  • 6Department of Dermatology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.

Abstract

OBJECTIVES:

Insulin-derived amyloidosis is a rare skin-related complication of insulin therapy. The purpose of this study was to show the effects of insulin-derived amyloidosis on blood glucose levels, insulin dose requirements, and insulin absorption.

METHODS:

Seven patients were found to have insulin-derived amyloidosis at the Tokyo Medical University Ibaraki Medical Center. The clinical characteristics and insulin therapy of the 7 patients were investigated. Insulin absorption was studied by comparing the serum insulin levels after insulin injections into insulin-derived amyloidosis sites versus injections into normal sites in 4 patients.

RESULTS:

When the insulin-derived amyloidosis was discovered, the mean hemoglobin A1c level was 9.3%, and the mean daily insulin dose was 57 units. After changing the injection sites to avoid the insulin-derived amyloidosis, the blood glucose concentrations improved, and the mean daily insulin dose could be reduced to 27 units (P = .035; 53% reduction). The insulin absorption at insulin-derived amyloidosis sites was 34% of that at normal sites (P = .030).

CONCLUSIONS:

Insulin-derived amyloidosis caused poor glycemic control and increased insulin dose requirements because of impairments in insulin absorption.

Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Amyloidosis; Insulin absorption; Insulin dose; Insulin therapy

PMID:
24462809
[PubMed - indexed for MEDLINE]
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