Efecto de la lipohipertrofia en el control metabólico de pacientes con diabetes mellitus tipo 2

Universidad Nacional de Colombia. Facultad de Medicina. Revista

Pinilla-Roa, Análida Elizabeth¹  Ortiz-Roa, Cynthia¹ 

[1] Universidad Nacional de Colombia, Bogotá, Colombia

关键词: Lipodystrophy;    Insulin;    Diabetes Mellitus;    Insulin Resistance;    Insulin;    Long-Acting (MeSH).;   

DOI  :  10.15446/revfacmed.v65n4.53108

学科分类：医学（综合）

来源: Universidad Nacional de Colombia * Facultad de Medicina

【 摘 要 】

Lipodystrophy (lipohypertrophy, lipoatrophy) is one of the most common complications of subcutaneous insulin injections. This paper presents the case of a 46-year-old patient with uncontrolled type 2 diabetes mellitus, treated with insulin glargine 45UI/day, no glycemic control and multiple adjustments and hospitalizations. On admission, self-monitoring showed off-target basal and postprandial values, baseline glucose of 299 mg/dL and HbA1c of 11%. Medical history revealed flaws in the technique used for insulin administration, particularly, lack of application site rotation. Physical examination allowed to observe lipohypertrophy caused by excess bilateral infraumbilical adipose panniculus and induration of the subcutaneous cellular tissue. Ultrasound exposed fat infiltration in anterior recti. The patient was instructed on the correct technique for applying insulin with daily rotation of the application site, and allowing the areas affected by lipohypertrophy to rest. A self-monitoring guide was also provided. Self-monitoring within the first 10 days showed improvement in baseline glucose levels up to 116 mg/dL and borderline value of 75 mg/dL, compared to the previous baseline blood glucose level of 242 mg/dL with the same type of insulin and dose. Close follow-up was done to define the required insulin dose and to monitor possible hypoglycemia, obtaining an improvement in HbA1c of 9.2% and 8.8% at 4 and 11 months, respectively.

【 授权许可】

CC BY