Insulin-derived Amyloidosis and Poor Glycemic Control: A Case Series - 22/04/14

Doi : 10.1016/j.amjmed.2013.10.029

Terumasa Nagase, MD, PhD ^a,^⁎ , 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
^a Department of Metabolism and Endocrinology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan
^c Department of Radiology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan
^d Department of Plastic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan
^e Department of Dermatology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan
^b Department of Pathology, National Defense Medical College, Tokorozawa, Saitama, Japan

^∗Requests for reprints should be addressed to Terumasa Nagase, MD, PhD, Tokyo Medical University Ibaraki Medical Center, Department of Metabolism and Endocrinology, 3-20-1 Chuou, Ami, Ibaraki 300-0395, 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.

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Keywords : Amyloidosis, Insulin absorption, Insulin dose, Insulin therapy

Esquema

Materials and Methods

☆	This is an open access article under the CC BY-NC-ND license (3.0/).
	Funding: None.
	Conflict of Interest: None.
	Authorship: All authors had access to the data and played a role in writing this manuscript.