Conference Resources | Abstracts
September 3
rd
– 6
th
, 2014 | Toronto, Canada |
250
P162
Insulin edema in an adolescent with newly diagnosed type 1 diabetes mellitus
C. Henderson
1
, P. Luca
1
1
Alberta Children's Hospital, Pediatric Endocrinology, Calgary, Canada
Objectives:
To describe a case of insulin edema requiring diuretic therapy, and to review the existing
literature on this condition.
Methods:
We describe a case of a 15-year-old male with newly diagnosed type 1 diabetes (DM1) who
developed edema of the lower extremities one day after initiation of subcutaneous insulin therapy.
Other causes of edema were excluded. Similar to previously described cases, the patient was an
underweight adolescent (BMI 15.2kg/m
2
at diagnosis) and required high doses of insulin (maximum
2.9units/kg/d). Ongoing fluid retention was evident with worsening edema in the lower extremities and
periorbitally, as well as marked weight gain (18.6kg) over a six-week period following diagnosis.
Furosemide therapy was therefore initiated.
Results:
The edema significantly improved on furosemide, and treatment was discontinued after a
four-week course with no subsequent recurrence of edema. In previously reported pediatric cases,
patients have been between the ages of 10-16yrs, are typically underweight at diagnosis, and in most
cases required more than 1 unit/kg/d of insulin to achieve glycemic control. Of the cases we found,
71% spontaneously resolved and 29% required treatment with furosemide or ephedrine. The
pathogenesis of insulin edema has been attributed primarily to a direct antinatriuretic effect of insulin
on the kidneys and an increase in vascular permeability.
Conclusion:
Insulin edema is a rare complication of DM1 that can occur in children and adults after
initiating or intensifying insulin therapy. It is typically self-resolving, but cases requiring treatment have
been reported. Furosemide for four weeks was an effective therapy in our patient.
