Insulin-derived amyloidosis and poor glycemic control: a case series.
OBJECTIVE
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.
Department of Metabolism and Endocrinology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan. Electronic address: tnagase@tokyo-med.ac.jp.
Terumasa
T
Nagase
Department of Pathology, National Defense Medical College, Tokorozawa, Saitama, Japan.
Keiichi
K
Iwaya
Department of Metabolism and Endocrinology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.
Yoshiki
Y
Iwaki
Department of Radiology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.
Fumio
F
Kotake
Department of Plastic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.
Ryuji
R
Uchida
Department of Dermatology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.
Tsunao
T
Oh-i
Department of Metabolism and Endocrinology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.
Hidenori
H
Sekine
Department of Metabolism and Endocrinology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.
Kazuhiro
K
Miwa
Department of Metabolism and Endocrinology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.
Satoshi
S
Murakami
Department of Metabolism and Endocrinology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.
Tomotada
T
Odaka
Department of Metabolism and Endocrinology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.
Masahiko
M
Kure
Department of Metabolism and Endocrinology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.
Yoko
Y
Nemoto
Department of Metabolism and Endocrinology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.
Masayuki
M
Noritake
Department of Metabolism and Endocrinology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.
Yoshiya
Y
Katsura
D000042:Absorption; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000139:chemically induced*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000097:blood; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects* / Q000097:blood; D007564:Japan; D008297:Male; D008875:Middle Aged
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
Amyloidosis; Insulin absorption; Insulin dose; Insulin therapy