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

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• 作者：Terumasa Nagase ; MD ; PhD^a ; ^{tnagase@tokyo-med.ac.jp" class="auth_mail} ; Keiichi Iwaya ; MD ; PhD^b ; Yoshiki Iwaki ; MD ; PhD^a ; Fumio Kotake ; MD ; PhD^c ; Ryuji Uchida ; MD ; PhD^d ; Tsunao Oh-i ; MD ; PhD^e ; Hidenori Sekine ; MD^a ; Kazuhiro Miwa ; MD^a ; Satoshi Murakami ; PhD^a ; Tomotada Odaka ; MD ; PhD^a ; Masahiko Kure ; MD ; PhD^a ; Yoko Nemoto ; MD ; PhD^a ; Masayuki Noritake ; MD ; PhD^a ; Yoshiya Katsura ; MD ; PhD^a
• 关键词：Amyloidosis ; Insulin absorption ; Insulin dose ; Insulin therapy
• 刊名：The American Journal of Medicine
• 出版年：May 2014
• 年：2014
• 卷：127
• 期：5
• 页码：450-454
• 全文大小：772 K

文摘

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.