Lipoatrophy(depression at the insulin injection site).
This complication is seen with old types of insulin and disappears when a patient is switched
to purified pork insulin.
Administration of purified insulin must be continued after resolution of the lipoatrophy,
however, because reexposure to the less pure
insulin, even though at a different injection site, can
cause a reappearance of the atrophy that is resistant to
subsequent treatment with the more purified forms.
Local allergy and lipo ( fat) atrophy are seen as a coincidence in some cases suggesting immune component of lipoatrophy.
Reduction of the atrophy is seen with local injection of steroids which suppress immunity.
Insulin hypertrophy (fat hypertrophy at injection
site). This complication may also have an immune
component. It does not always respond to therapy with purified insulins, however, with improvement occurring in only about 50% of the patients.
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Allergic reactions to insulin.
Local allergic responses can occur within 15 minutes to 4 hours after the injection. Common allergies often occur one to four weeks after institution of insulin therapy or within a few days of reinstitution of insulin and are seen as a hard, red induration at the injection site.
The longer acting insulins are more likely to induce allergy. Protamine, is a significant antigen.
Systemic allergic responses
These occur as urticaria or angioedema, or both, which is mediated by IgE antibodies.
In urticaria, one gets rash on body or hives, is an allergic or non-allergic) condition. Chronic urticaria needs treatment - antihistamines, homeopathy and cortisone
Systemic allergic reactions to insulin can be dangerous and life threatening. Discontinue insulin if possible. If continuing insulin is necessary, patient should be desensitized using purified insulins and then maintenance doses of insulin must be administered to maintain the desensitization. These people might be allergic to penicillin.
Diabetologists, Ophthalmologists have to face this challenge of managing patients.