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Insulin Edema in a Patient With Cystic Fibrosis–Related Diabetes

Diabetes Care
American Diabetes Association
Publication Date
DOI: 10.2337/dc11-1952
  • Diabetes Care Electronic Pages
  • Online Letters: Observations
  • Education
  • Medicine


DC111952 6..6 OBSERVATIONS Insulin Edema in a PatientWith Cystic Fibrosis–Related Diabetes Insulin edema is a rare complication ofinsulin therapy primarily seen withnewly diagnosed or uncontrolled di- abetes (1–3). Patients at risk are those who are beginning insulin treatment, un- derweight, 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 re- vealed few case reports of insulin edema and no reports of insulin edema in a pa- tient 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, andwithin 1month, 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) re- vealed lower extremity (LE) edema to the midcalf. Three months later, her HbA1c increased to 12.5%. The patient’s pump download data revealed that insu- lin had only been administered for 2 non- consecutive days before her appointment. Almost 1 year after a pump re-education session (August 2009), the patient’s HbA1c decreased to 11.8%. Pump down- load data revealed increased bolus intake as the patient’s appointment neared. PE revealed nonpitting LE edema. All of the potential causes of edema were consid- ered, including cardiac abnormalities, liver impairment, and transplant medica- tions. 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 clinic appoint- ment. The patient again complained of swelling in her legs and face, stating that it was worse when tak

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