Insulin-derived Amyloidosis and Poor Glycemic Control: A Case Series

• Published in: The American journal of medicine Vol. 127; no. 5; pp. 450 - 454
• Main Authors: Nagase, Terumasa, Iwaya, Keiichi, Iwaki, Yoshiki, Kotake, Fumio, Uchida, Ryuji, Oh-i, Tsunao, Sekine, Hidenori, Miwa, Kazuhiro, Murakami, Satoshi, Odaka, Tomotada, Kure, Masahiko, Nemoto, Yoko, Noritake, Masayuki, Katsura, Yoshiya
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2014; Elsevier Sequoia S.A
• Subjects: Absorption; Adult; Aged; Aged, 80 and over; Amyloidosis; Amyloidosis - chemically induced; Biomarkers - blood; Blood Glucose - metabolism; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Glycated Hemoglobin A - metabolism; Humans; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - blood; Injections, Subcutaneous; Insulin; Insulin - administration & dosage; Insulin - adverse effects; Insulin - blood; Insulin absorption; Insulin dose; Insulin therapy; Insulin-like growth factors; Internal Medicine; Japan; Male; Medical treatment; Middle Aged; Studies; Insulin therapy; Amyloidosis; Insulin absorption; Insulin dose
• ISSN: 0002-9343; 1555-7162; 1555-7162
• DOI: 10.1016/j.amjmed.2013.10.029

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