Poor glycaemic control caused by insulin induced lipohypertrophy

doi:10.1136/bmj.327.7411.383

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Tahseen A Chowdhury (Tahseen.Chowdhury@bartsandthelondon.nhs.uk), consultant in diabetes1,
Valerie Escudier, senior diabetes specialist nurse1

¹ Mile End Diabetes Centre, The Royal London Hospital, London E1 4DG

Correspondence to: T A Chowdhury

Accepted 5 March 2003

Introduction

Good glycaemic control reduces the risk of complications of diabetes.1 Secondary failure of oral hypoglycaemic treatment is common in patients with type 2 diabetes, and thus insulin treatment is often needed to improve glycaemic control. Indeed, in the UK prospective diabetes study 38% of patients with type 2 diabetes needed insulin treatment after 10 years.1 The reasons for poor glycaemic control are many; and despite insulin treatment many patients with diabetes have poor glycaemic control.2 Lipohypertrophy is characterised by a benign “tumour-like” swelling of fatty tissue secondary to subcutaneous insulin injections. We describe two cases in which poor glycaemic control was directly related to insulin induced lipohypertrophy, recognition of which led to major improvements in glycaemic control.

Case reports

Case 1

A 37 year old woman had been given a diagnosis of type 1 diabetes when she was 7 years old. She was treated with soluble insulin twice daily. She was transferred to our diabetes unit in 2000. She had experienced problems with fluctuating blood glucose concentrations, recurrent hyperglycaemia, and frequent unpredictable hypoglycaemia, despite compliance with diet and regular self monitoring of blood glucose. At her most recent annual review she was noted to have mild background retinopathy but no other microvascular or macrovascular complications of diabetes. Results of lipid, urea and electrolytes, and thyroid function tests were normal, but her glycated haemoglobin was 9.1% (normal range 3.6% to 5.1%). She was treated with Human Actrapid (Novo Nordisk) at a …