Insulin-induced edema in a pediatric patient - clinical case

  • Catarina Ferraz de Liz Department of Pediatric and Neonatology, Centro Hospitalar do Tâmega e Sousa
  • Joaquim Cunha Department of Pediatric and Neonatology, Centro Hospitalar do Tâmega e Sousa
  • Susana Lira Department of Pediatric and Neonatology, Centro Hospitalar do Tâmega e Sousa
Keywords: children and adolescents, complication, diabetes mellitus type 1, insulin, edema

Abstract

Introduction: Insulin edema is a rare condition associated with improved glycemic control shortly after diabetes diagnosis or following a period of insulin omission. Clinical findings range from mild edema to severe heart failure and pleural effusion. Diagnosis is clinical and other edema causes should be excluded. Since it is a self-limited condition, there is no need to modify insulin regimen. In more severe cases, diuretic therapy may be required.
Clinical case: A 14-year-old female was brought to the Emergency Department due to weight gain and leg swelling with three days of evolution. She had been diagnosed with type 1 diabetes at the age of nine. The girl had poor metabolic control which led to multiple hospitalizations, the last one occurring the week before with a glycated hemoglobin higher than 15%. In physical examination, lower limb edema and a 7-kg weight gain were noted. No jugular vein distension, hepatomegaly, or other forms of edema were found. The girl was hemodynamically stable, with diuresis within the normal range. Analytical study consisting of hemogram, ionogram (sodium and potassium), and renal and hepatic function was normal. Urine analysis revealed glycosuria and chest x-ray showed no abnormalities. The diagnosis of insulin-induced edema was established and water and saline restriction recommended, with total symptom resolution three weeks later.
Conclusion: Despite rare, clinicians should be aware of this condition, as most cases do not require modifying the insulin regimen.

References

Aravamudhan A, Gardner C, Smith C, Senniappan S. Insulin oedema in a child with newly diagnosed diabetes mellitus. European Journal of Pediatrics. 2013; 173:685-7.

Adamo L, Thoelke M. Generalised insulin oedema after intensification of treatment with insulin analogues. BMJ Case Rep. 2013; 2013: bcr2012007037.

Chaker F, Yazid M, Chihaoui M, Rached A, Slimane H. Insulin-Induced Edema: An Unusual Complication in a Patient With Diabetic Ketosis. Tunis Med. 2017; 95:142-4.

Lawrence JR. Diabetic (insulin) oedema. BMJ. 1979; 2:445.

Kan Y, Anno T, Kawasaki F, Takai M, Shigemoto R, Kaneto H, et al. Bilateral lower limb edema induced by rapid improvement of glycemic control with insulin therapy in a subject with poorly controlled type 2 diabetes. Acta Diabetologica. 2017; 54:611-3.

Klisic J, Hu M, Nief V, Reyes L, Fuster D, Moe O, et al. Insulin activates Na+/H+ exchanger 3: biphasic response and glucocorticoid dependence. American Journal of Physiology-Renal Physiology. 2002; 283:F532-9.

Kalambokis G, Tsatsoulis A, Economou G, Tsianos E. A case of insulin edema with inappropriate hyperaldosteronism. Journal of Endocrinological Investigation. 2004; 27:957-60.

Chelliah A, Burge MR. Insulin edema in the twenty-first century: review of the existing literature. J Investig Med 2004; 52:104–8.

Goturu A, Jain N, Lewis I. Bilateral cataracts and insulin oedema in a child with type 1 diabetes mellitus. Case Reports. 2013; 2013:bcr2012008235.

Bas V, Cetinkaya S, Yilmaz Agladioglu S, Peltek Kendirci H, Bilgili H, Yildirim N, et al. Insulin Oedema in Newly Diagnosed Type 1 Diabetes Mellitus. Journal of Clinical Research in Pediatric Endocrinology. 2010; 2:46-8.

Greco D. Severe Weight Gain and Generalized Insulin Edema after the Starting of an Insulin Pump. Canadian Journal of Diabetes. 2015; 39:21-3.

Rothacker K, Kaye J. Insulin oedema and treatment-induced neuropathy occurring in a 20-year-old patient with Type 1 diabetes commenced on an insulin pump. Diabetic Medicine. 2013; 31:e6-e10.

Published
2020-03-24
How to Cite
Ferraz de Liz, C., Cunha, J., & Lira, S. (2020). Insulin-induced edema in a pediatric patient - clinical case. NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL, 29(1), 43-46. https://doi.org/10.25753/BirthGrowthMJ.v28.i2.15709
Section
Case Reports