Objective: Our objective was to assess the prevalence of cutaneous complications including insulin derived amyloidosis in insulin-injecting diabetes patients and to study the role of ultrasonography (in comparison to gel-assisted palpation) in early diagnosis of lipohypertrophy.
Methods: This was a cross-sectional study conducted at a tertiary care center in India. A total of 500 patients injecting insulin for two or more years were enrolled and subjected to ultrasonographic examination of abdominal wall to look for presence of lipohypertrophy (LH). All cases with radiological evidence of LH were given the option of punch biopsy of the skin and subcutaneous tissue to look for insulin associated amyloidosis.
Results: Clinical examination detected LH in 44.6% of patients. Ultrasonography diagnosed additional 13.4% of patients with LH which were missed on clinical examination. Incorrect rotation of sites (P < 0.001) and insulin syringe reusage for more than five times (P < 0.001) significantly increased the risk of LH . Skin biopsy was performed in 100 cases, of which two patients showed apple green birefringence and positive staining with anti-insulin antibody suggestive of insulin derived amyloidosis.
Conclusion: Ultrasonography is more objective and reliable method of detecting LH. Insulin-derived amyloidosis may be a more common complication of insulin therapy than previously thought.
S. Arora: None.