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Insulin Edema In Diabetes

Natural Course Of Insulin Edema

Natural Course Of Insulin Edema

Abstract Generalized edema due to water retention is a very rare complication of insulin therapy. It affects mainly patients with newly diagnosed diabetes or patients with chronic hyperglycemia following initiation of insulin therapy. When it occurs, it is treated effectively with diuretics. This case report describes a female patient, who developed severe insulin edema following initiation of insulin. Diuretics were not given due to severe side effects, thus the natural outcome of insulin edema was observed. Edema was gradually replaced by fat tissue with persistent weight gain. Physicians treating diabetic patients should be aware of "insulin edema" in the differential diagnosis of weight gain in patients treated with insulin. Discover the world's research 14+ million members 100+ million publications 700k+ research projects Join for free Continue reading >>

Generalized Edema Immediately Following Insulin Control In Diabetes Mellitus

Generalized Edema Immediately Following Insulin Control In Diabetes Mellitus

A pronounced generalized edema occurring in diabetic patients immediately following desugarization of the urine with insulin therapy was observed five times last year in this clinic. The edema promptly disappeared after treatment with potassium bicarbonate and potassium chlorid, 0.6 gm. each three times a day with meals. Thus far we have found no case reports in this country of this annoying untoward effect of insulin control in diabetes. However, edema with insulin therapy has been noted in the German clinics. Hagedorn 1 explains an increase in weight of insulin patients with cessation of the diabetic symptoms as partly a water retention. Edema induced by insulin is reported by von Jaksch-Wartenhorst,2 by von Noorden and Isaac,3 and by Klein.4 It may be mentioned that these writers employed insulin preparations made in Europe, which may have been more effective in inducing water retention through less complete removal of proteins Continue reading >>

Insulin Edema In Diabetes Mellitus Associated With The 3243 Mitochondrial Trnaleu(uur) Mutation; Case Reports - Sciencedirect

Insulin Edema In Diabetes Mellitus Associated With The 3243 Mitochondrial Trnaleu(uur) Mutation; Case Reports - Sciencedirect

Volume 29, Issue 2 , August 1995, Pages 137-142 Insulin edema in diabetes mellitus associated with the 3243 mitochondrial tRNALeu(UUR) mutation; Case reports Author links open overlay panel YoshihikoSuzuki Get rights and content We encountered a patient with diabetes mellitus due to the 3243 mitochondrial tRNA mutation(DM-Mt3243), who developed insulin edema and hepatic dysfunction after starting insulin. Such a rare phenomenon was unlikely to be a fortuitous coincidence in mitochondrial diabetes, as none in 197 non-mutant NIDDM patients had same episode. Moreover, similar leg edema was noticed in another DM-Mt3243 patient, and other two DM-Mt3243 patients had leg edema which responded to coenzyme Q10. These observations suggest further a role of mitochondrial function on leg edema. The mechanism of his insulin edema may involve vasomotor changes induced by the rapidly glycemic control, because our case of insulin edema had a prominent increase of strong succinate dehydrogenase reactive vessels. Alternatively, myocardial dysfunction might have produced leg edema and hepatic dysfunction, because he had subclinical myocardial dysfunction, judged by imaging with -methyl-p-(123I)- iodophenyl-pentadecanoic acid. The third explanation is that a rapid improvement of glycemic control might have induced hepatic reoxygenation and the production of reactive oxygen species in the liver that contributed to cell damage. Thus, although we cannot draw definite conclusion, our experiences here suggest that mitochondrial dysfunction is important in the etiology of insulin edema. Continue reading >>

Insulin Edema In The Twenty-first Century: Review Of The Existing Literature.

Insulin Edema In The Twenty-first Century: Review Of The Existing Literature.

Abstract Generalized insulin edema, although rare, is a well-recognized complication of insulin therapy. It is mainly appreciated in patients with newly diagnosed or poorly controlled diabetes mellitus after starting intensive insulin therapy. Although the condition is self-limiting, progression to overt cardiac failure and development of pleural effusion have been reported. With current trends toward intensive insulin therapy, clinicians should be aware of the existence of the insulin edema syndrome, and its occurrence should be documented and differentiated from other causes of edema. In this article, we present a recent case that illustrates the clinical features of insulin edema. Specifically, a young male with newly diagnosed type 1 diabetes mellitus developed significant, reversible peripheral edema after starting insulin therapy. A detailed case description is accompanied by the only known published photographs of insulin edema. The overall purpose of this article is to review the scanty existing medical literature surrounding the topic of insulin edema and to raise awareness about its continued occurrence. Continue reading >>

Case Report: Insulin Edema And Acute Renal Failure

Case Report: Insulin Edema And Acute Renal Failure

Generalized edema due to insulin is a rare phenomenon. We report a 35-year-old woman with newly diagnosed type 1 diabetes who presented with generalized edema, serous effusions, and acute renal failure a few hours after starting insulin. The patient presented with diabetic ketoacidosis after a 12-month history of polydipsia and polyuria. She had lost 2 kg over a 2-month period and weighed 47 kg, BMI 18 kg/m2. Blood pressure was 131/84 mmHg. Clinical examination showed Kussmaul dyspnea, but was otherwise normal. Biological findings were consistent with severe diabetic ketoacidosis: pH 6.80, bicarbonate 1.4 mmol/L. Plasma glucose was 23 mmol/L and HbA1c 13.3% (122 mmol/mol). Serum creatinine concentration was 90 μmol/L. The patient received a total of 15 L of intravenous fluids over a 96-h period. Insulin therapy was started at a rate of 8 units/h. Subcutaneous insulin was initiated on the second day, total daily dose 30 units. From the second day on, serum creatinine concentration began to increase, up to 253 μmol/L; estimated glomerular filtration rate 18 mL/min, accompanied by generalized edema. A computed tomography scan, performed when serum creatinine concentration and body weight had already started to increase, showed bilateral pleural effusions and abundant peritoneal effusion. The morphology of the kidneys was normal, and there was no sign of obstruction. A sample of pleural fluid was obtained; protein concentration was 19 g/L. At day 5 the patient had gained 16 kg, the serum creatinine concentration was 260 μmol/L and serum albumin concentration was 22 g/L. Furosemide was started, 80 mg/day. Both body weight and serum creatinine concentration immediately started to decrease and returned to baseline within a couple of days. At day 30, body weight was 54 kg an Continue reading >>

Swelling (edema) And Diabetes - Swelling In The Legs, Ankles And Feet

Swelling (edema) And Diabetes - Swelling In The Legs, Ankles And Feet

Tweet Edema (known as oedema in the UK) is a build up of fluid in the body (water retention) which causes swelling. Edema commonly affects the legs, ankles, feet and wrist. Water retention is often treatable, with treatment varying depending on the cause. Symptoms of edema The main symptom of edema is swelling of the affected area. Other symptoms that may occur, along with swelling, include: Weight gain Aching limbs Stiff joints Discolouration of skin Hypertension (high blood pressure) What causes swelling in the legs, feet and ankles? Swollen ankles and legs will often be brought on, or aggravated, by long periods of standing. A number of medications can increase the risk of oedema. Such medications include corticosteroids, blood pressure medications and the contraceptive pill. Water retention may also be caused by a number of conditions including: A high intake of salt can increase the problems of swelling in people with kidney disease. Treatment for edema Treatment for edema may vary depending on the cause. Water retention may be resolved if the underlying cause can be adequately treated. Regular physical activity and preventing long periods of standing can help reduce water retention. A low dietary salt intake is advisable, particularly if fluid retention has been brought on by kidney disease. If you are overweight, weight loss can help with reducing fluid retention. Diuretics, also known as ‘water tablets’, help to remove fluid from the body and may be prescribed for some causes of oedema. Prevention You can reduce your risk of edema by taking steps to prevent kidney disease and heart failure from developing. This can be achieved through good control of blood glucose levels, regular exercise and a healthy diet. If you can avoid long periods of standing, this wi Continue reading >>

Insulin Edema In Type 1 Diabetes Mellitus: Report Of A Case And Brief Review Of The Literature

Insulin Edema In Type 1 Diabetes Mellitus: Report Of A Case And Brief Review Of The Literature

Dear editor, Despite the essential role of insulin therapy in the management of patients with insulin deficiency, insulin itself may lead to adverse effects such as hypoglycemia and weight gain (1, 2). Additionally, crucial fluid retention can also occur rarely, resulting in an edematous condition. Peripheral or generalized edema is an extremely rare complication of insulin therapy, which mostly occurs after the initiation of intensive insulin therapy (3, 4). Here we report a 12-year-old boy with newly diagnosed type 1 diabetes, presented with edema of the lower extremities about one week after the initiation of insulin therapy with a brief review of the literature. A 12-year-old boy was admitted to the hospital with an acute presentation of DKA. In his history, polyuria and polydipsia were present for two months with a recent weight loss of 4 kg. No family history of diabetes was reported. On physical examination, his height was 152 cm (-0.31 SD) and weight was 30 kg (-1.75 SD), body mass index was 13 kg/m2 (P < 3), heart rate was 110 minutes, blood pressure 100/70 mmHg. He had somnolance, mild dehydration, and “Kussmaul” breathing. Findings of other systems on examination were within normal range. Laboratory findings; blood glucose level was 800 mg/dL, ketonuria with acidosis was present with venous blood pH of 7.0. HbA1c level was 16% (normal range 4% - 6%). He was initially treated with intravenous insulin infusion and isotonic saline (in 5% dextrose). After completing intensive DKA treatment, subcutaneous regular insulin treatment was started for determination of daily insulin requirement. And then it was switched to intensive insulin regimen as fast acting insulin (insulin lispro) before meals and insulin glargine at bed time with a total daily insulin require Continue reading >>

Insulin Therapy And Weight Gain

Insulin Therapy And Weight Gain

Authors: George Y. Chao, MD Faculty and Disclosures Why do patients gain weight while on insulin therapy? Medical Director, Diabetes Program, Memorial Hospital, Modesto, California; Chief, Division of Endocrinology, Sutter Gould Medical Foundation, Modesto, California It is well known that insulin treatment is associated with weight gain. Before the discovery of insulin, the treatment of type 1 diabetes mellitus was limited to a "starvation diet," and most patients became quite cachectic and emaciated before they died. When the first patients were treated with insulin, their glycemic control improved; their nutritional status improved; and all of them regained the weight that they had lost. Several reasons may account for the weight gain associated with insulin therapy. First, insulin therapy quickly improves hyperglycemia. Such rapid improvement of glucose levels may lead to "insulin edema" with associated weight gain from fluid retention. With improvement of hyperglycemia, glycouria and calorie-wasting due to glycouria are eliminated. Unless the patient can burn off the excess calories retained due to improved glycemic control, weight gain may be the consequence of improved glycemic control. Insulin may also cause hypoglycemia, and the extra calories consumed by patients to treat hypoglycemic episodes may also contribute to weight gain. In addition, insulin is an anabolic hormone, and may indeed have appetite-stimulating effects. Other mechanisms that may account for the weight gain associated with insulin therapy need to be explored. For example, recent studies have suggested that the amount of weight gain may be dependent on the type of insulin used. Further understanding of the differential effects of different insulins on weight gain may shed some light on this i Continue reading >>

Insulin Edema In A Patient With Cystic Fibrosis–related Diabetes

Insulin Edema In A Patient With Cystic Fibrosis–related Diabetes

Insulin edema is a rare complication of insulin therapy primarily seen with newly diagnosed or uncontrolled diabetes (1–3). Patients at risk are those who are beginning insulin treatment, underweight, or increasing their insulin dose either in the normal course of the disease or after diabetic ketoacidosis (1,4). The prevalence of insulin edema is unknown; a review of the literature revealed few case reports of insulin edema and no reports of insulin edema in a patient with cystic fibrosis–related diabetes (CFRD). This case report illustrates the effects of insulin edema in a 23-year-old female patient who was diagnosed with CFRD at the age of 16 years. The patient presented to the pediatric endocrine clinic at the age of 16 years with an HbA1c of 9.8%. She started therapy on an insulin pump, and within 1 month, her HbA1c level fell within target range, and a lung transplant occurred in December 2007. One year later, her HbA1c increased to 11.9%, and physical exam (PE) revealed lower extremity (LE) edema to the midcalf. Three months later, her HbA1c increased to 12.5%. The patient's pump download data revealed that insulin had only been administered for 2 nonconsecutive days before her appointment. Almost 1 year after a pump re-education session (August 2009), the patient's HbA1c decreased to 11.8%. Pump download data revealed increased bolus intake as the patient's appointment neared. PE revealed nonpitting LE edema. All of the potential causes of edema were considered, including cardiac abnormalities, liver impairment, and transplant medications. Furosemide was prescribed but did not resolve the edema. Six months later, the patient's HbA1c increased to 16.5%. Consistent with prior visits, her pump download data revealed insulin delivery only on the 2 days before c Continue reading >>

Diabetic Legs Swelling Causes And Remedies

Diabetic Legs Swelling Causes And Remedies

Many people suffering from diabetes complain about swelling in legs and feet. Usually, this swelling is painless and due to retention of fluid. There can be numerous reasons leading to such retention, from very high and uncontrolled sugar levels (which is dangerous for various organs) to the secondary complications of diabetes. Usually, fluid retention indicates that either heart of a diabetic person has become weak. Thus there is a poor flow of fluids, or kidneys are not functioning properly. In some cases, it may be due to liver disease or some anti-diabetic medications. Other reasons of such swelling could be a disease of blood vessels, or deficit of certain micronutrients and electrolytes(“Swelling and Diabetes – Swollen Legs, Ankle & Feet, Peripheral Edema,” n.d.). Let us look in detail at some leading causes of swelling of legs in diabetes. Congested heart failure The major complication of diabetes is weakening of heart and blood vessels. Congested Heart Failure (CHF) often coexists in diabetes(Nasir & Aguilar, 2012). In fact, a person suffering from diabetes is at much higher risk of heart failure(Nichols, Gullion, Koro, Ephross, & Brown, 2004). In CHF though the heart is functioning, but its pumping power is compromised, which means that it is not strong enough for blood to circulate properly in our body. Things are further made worse by stiffening of arteries(“Heart failure,” n.d.). All this leads to swelling and accumulation of fluids in the legs. Kidney failure More than one-third people suffering from diabetes have chronic kidney disease(“Diabetes and Chronic Kidney Disease,” 2014). Diabetes is slowly emerging one of the leading causes of chronic kidney disease. Almost half of people going for dialysis, also have diabetes(Cavanaugh, 2007). In d Continue reading >>

An Unusual Cause Of Generalized Insulin Edema And Truncal Neuropathy | Tufton | Journal Of Medical Cases

An Unusual Cause Of Generalized Insulin Edema And Truncal Neuropathy | Tufton | Journal Of Medical Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc Volume 6, Number 12, December 2015, pages 563-565 An Unusual Cause of Generalized Insulin Edema and Truncal Neuropathy Nicola Tuftona, b, Simon Coppacka, Bobby Hudaa aDepartment of Diabetes, Royal London Hospital, Barts Health NHS Trust, London, UK bCorresponding Author: Nicola Tufton, Department of Diabetes & Metabolism, John Harrison House, Royal London Hospital, Barts Health NHS Trust, Whitechapel, London E1 1BB, UK Manuscript accepted for publication October 16, 2015 Insulin edema and acute neuropathy are rare side effects of insulin initiation or rapid improvement in glycemic control. Both conditions occurring simultaneously are very rare and there are no previous data on truncal neuropathy as a dominant feature. A 35-year-old lady, who presented with an infected, necrotic fourth finger and was admitted for debridement and antibiotics, developed diabetic ketoacidosis. Past medical history included latent autoimmune disease of adults. She was non-compliant with medication and had experienced significant weight loss (37 kg; body mass index (BMI) 15.1 kg/m2). She was glutamic acid decarboxylase antibody positive, with poor glycemic control (HbA1c 133 mmol/mol (14.3%)). She was treated with intravenous and then subcutaneous insulin. From day 3, she developed significant pitting edema to her umbilicus. She was treated with furosemide 40 mg once daily and fluid restriction. Other causes of edema were excluded. Peak weight gain was 5 kg and edema resolved 2 weeks later. She also developed a painful sensory neuropathy over dermatomes T12-L2 on day 5, which persisted for several months before resolution Continue reading >>

Natural Course Of Insulin Edema

Natural Course Of Insulin Edema

Abstract Generalized edema due to water retention is a very rare complication of insulin therapy. It affects mainly patients with newly diagnosed diabetes or patients with chronic hyperglycemia following initiation of insulin therapy. When it occurs, it is treated effectively with diuretics. This case report describes a female patient, who developed severe insulin edema following initiation of insulin. Diuretics were not given due to severe side effects, thus the natural outcome of insulin edema was observed. Edema was gradually replaced by fat tissue with persistent weight gain. Physicians treating diabetic patients should be aware of “insulin edema” in the differential diagnosis of weight gain in patients treated with insulin. Continue reading >>

Edema

Edema

Abnormal accumulation of fluid in various body tissues, causing swelling. The swelling may affect any of a number of body sites, such as the legs, ankles, and feet; the hands; the back or abdomen; and even the eyelids. Edema may be caused by a number of different medical conditions and can also be a side effect of certain drugs. Here are some possible causes: Congestive heart failure may result in edema. To compensate for heart failure, in which the heart fails to circulate adequate amounts of blood, the kidneys retain sodium to help the body hold on to water and increase the volume of blood. Deep vein thrombosis, the formation of a blood clot in a deep vein within the leg, can cause edema by damaging the valves within the veins that control normal blood flow. This type of edema most commonly makes the ankles swell but may also cause swelling in the calf or even the thigh. Kidney diseases, such as diabetic nephropathy, may cause edema due to excess sodium and fluid retention. Edema may be a side effect of certain drugs, including the oral diabetes drugs pioglitazone (brand name Actos) and rosiglitazone (Avandia). People sometimes experience mild edema when starting on insulin therapy, but this generally goes away within a few weeks. If you experience any unusual swelling, be sure to contact your doctor. It may be the result of a medical condition you don’t know you have. Treating edema involves treating the underlying medical condition that is causing it or adjusting medication as necessary. This article was written by Robert S. Dinsmoor, a Contributing Editor of Diabetes Self-Management. Disclaimer Statements: Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provide Continue reading >>

Lower Limb Oedema In Diabetes

Lower Limb Oedema In Diabetes

Rowan Hillson October 2, 2017 Vol 34.8 October 2017 Quincy (1719) advocated Pulvis Hydragosus for dropsy (oedema): Take Cream of Tartar Mechoacan, Jalap Dwarf-Elder seeds Gamboge Nutmegs Mix into a Powder. This is an admirable good Medicine It wonderfully brings down the swellings in Dropsies and Cachectick Constitutions.1 Later that century William Withering said: In the year 1775, my opinion was asked concerning a family receipt for the cure of the dropsy. I was told that it had long been kept a secret by an old woman in Shropshire who had sometimes made cures after the more regular practitioners had failed it was not very difficult to perceive, that the active herb could be no other than the Foxglove.2 It did indeed cure the dropsy although usually while demonstrating the plants considerable toxicity. Fluid accumulates in tissues when more fluid leaves capillaries than is cleared by the lymphatic system. Causes include: raised capillary pressure, for example in heart failure, fluid overload, or venous obstruction (such as thrombosis); reduced plasma osmotic pressure, for example with low plasma albumin; and increased capillary permeability, for example in infection or inflammation. Malformed or damaged lymphatics prevent adequate fluid drainage.3 Hi I have very swollen feet, and lower legs are now Rock hard, I am not sure this is diabetes related help please????? Xxx.4 People with diabetes can get oedema virtually anywhere legs, abdomen, lungs, maculae and may have multiple reasons for oedema. This article discusses lower limb oedema of course if that is present, fluid retention may be present elsewhere. Some causes are discussed. Lower limb oedema is usually obvious, often pitting on gentle pressure but non-pitting when chronic. Adipose tissue does not pit but obes Continue reading >>

Seven Tips For Dealing With Diabetes-related Fluid Retention

Seven Tips For Dealing With Diabetes-related Fluid Retention

Fluid retention, also known as edema, is a problem that affects many diabetics, especially those with type 2 diabetes. Water retention can occur in any part of the legs, including the feet, ankles, calves and thighs. There are several reasons why edema occurs, such as fluid buildup or from inflammation in injured or diseased tissue and joints. Types of Edema There are three types of diabetes-related fluid retention: The first type is called macular edema. Macular edema is a swelling that occurs in the macular, which is near the center of the retina. The retina is responsible for a number of duties such as the ability to read, daytime vision and color reception. Macular edema can cause diabetic retinopathy, which starts with the leaking of fluid from blood vessels into the macula. If not treated, this condition can blind a person. Pulmonary edema is the second type of fluid retention, which occurs if someone is using certain diabetic medications and if the person has cardiovascular problems. This type of edema can be treated inserting a catheter that drains the fluids. Foot and leg edema is the third type of edema and is also the most commonly discussed. Edema in the legs and feet can cause a high risk of non-healing wounds in diabetics. This type of edema is usually treated with manual decongestive therapy and diuretics. Medication Risks for Edema People who take thiazolidinedione medications are known to experience water retention. Thiazolidinediones are commonly used to treat type 2 diabetes as they help the body produce more insulin. However, one of the downsides of this medication is that it can lead to weight gain and edema. Preventing and Treating Edema Edema can have a lot of harmful effects if not treated like loss of vision. One of the main ways to stop fluid r Continue reading >>

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