Endocrine Abstracts

Generalised oedema as a rare complication of insulin treatment in the absence of renal, hepatic or cardiovascular disease was first described by Leifer in 1928. The true incidence of insulin oedema in children with type 1 diabetes mellitus is unknown and since it was first reported in 1979, there have been only 12 reported cases worldwide. Insulin oedema has been described both in patients with newly diagnosed diabetes receiving insulin therapy for the first time and also in those with established diabetes with a history of poor control. Insulin oedema is reported to have a higher incidence within the African population and in paediatrics is more common in females.

We report on the case of a 15-year-old girl of Caucasian origin with insulin dependent diabetes mellitus of 5 years duration with poor compliance and elevated HbA1c (>14%) who presented with diabetic ketoacidosis. Following appropriate management she was discharged home after 48 h on subcutaneous insulin but subsequently developed bilateral periorbital, pedal and sacral oedema. In the absence of cardiac, hepatic or renal disease a diagnosis of insulin oedema was made. She was given advice on a salt restriction diet and the oedema resolved spontaneously after a week.

Insulin oedema is a rare condition which should be considered in children who present with oedema following insulin therapy in the absence of any other cause. Insulin oedema is more likely to occur in patients with a low BMI and those receiving >1 unit/kg/day of insulin. Its identification is important since it generally follows a benign course and usually requires no treatment. The severity of insulin oedema can vary greatly from mild pedal oedema to severe generalised oedema. In most cases the oedema resolves spontaneously within a few weeks. Other patients have been treated with diuretics.