title: Relapsing insulin-induced lipoatrophy, cured by prolonged low-dose oral prednisone: a case report.
abstract: BACKGROUND
  Circumscript, progressing lipoatrophy at the insulin injection sites is an unexplained, however rare condition in diabetes mellitus.
  
  
  METHODS
  We report a case of severe localised lipoatrophy developing during insulin pump-treatment (continuous subcutaneous insulin infusion) with the insulin analogue lispro (Humalog®) in a woman with type-1 diabetes mellitus. After 11 months of progressing lipoatrophy at two spots on the abdomen, low-dose prednisone (5-10 mg) p.o. was given at breakfast for 8 months, whereby the atrophic lesions centripetally re-filled with subcutaneous fat tissue (confirmed by MRI) despite ongoing use of insulin lispro. However, 4 weeks after cessation of prednisone, lipoatrophy relapsed, but resolved after another 2 months of low-dose prednisone. No further relapse was noted during 12 months of follow-up on insulin-pump therapy with Humalog®.
  
  
  CONCLUSIONS
  Consistent with an assumed inflammatory nature of the condition, low-dose oral prednisone appeared to have cured the lipoatrophic reaction in our patient. Our observation suggests a temporary intolerance of the subcutaneous fat tissue to insulin lispro (Humalog®), triggered by an unknown endogenous mechanism.
authors.affiliation: Practice of Endocrinology and Diabetology, PD Dr,Kimmerle, Aachener Str,196, 40223 Düsseldorf/Germany. chantelau@gmx.de.
authors.forename: Ernst A
authors.initials: EA
authors.lastname: Chantelau
authors.forename: Ruth
authors.initials: R
authors.lastname: Praetor
authors.forename: Jörg
authors.initials: J
authors.lastname: Praetor
authors.forename: Ludger W
authors.initials: LW
authors.lastname: Poll