Does the use of insulin in a patient with liver dysfunction increase water retention in the body, i.e. cause insulin oedema?
A 68-year-old female with mild diabetes mellitus was admitted because of acute liver dysfunction due to autoimmune hepatitis. While 40 mg/day of prednisolone improved hepatic dysfunction dramatically, her diabetic milieu deteriorated seriously. The induced hyperglycaemia could not be controlled sufficiently, despite a high dose of insulin (> 110 units/day), suggesting the existence of insulin insensitivity and hyperinsulinaemia. Soon after introduction of insulin therapy, she developed severe anasarca, including marked peripheral oedema, ascites and pleural effusion. Anasarca eventually subsided within 4 weeks with the use of a diuretic agent. We conjectured that the side effects of insulin, such as anti-natriuresis and increased vascular permeability, might be pronounced in the presence of the hepatic dysfunction that accompanies insulin insensitivity, hyperinsulinaemia and hypoalbuminaemia.
Zenda
Takahiro
T
Department of Internal Medicine, Kanazawa Social Insurance Hospital, Japan. 2nai5ken@med.kanazawa-u.ac.jp
Murase
Yuko
Y
Yoshida
Isao
I
Muramoto
Hiroaki
H
Okada
Toshihide
T
Yagi
Kunimasa
K
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D004487:Edema / Q000150:complications*; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications*; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007328:Insulin / Q000009:adverse effects*; D007333:Insulin Resistance; D011241:Prednisone / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D007004:Hypoglycemic Agents; D007328:Insulin; D011241:Prednisone