Lipodystrophy With an Uncommon Clinical Presentation in a Patient With Insulin-Requiring Type 2 Diabetes Mellitus

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We report the case of a patient with type 2 diabetes mellitus (T2DM) on insulin therapy with a history of recurrent and severe hypoglycemia related to lipodystrophy with an uncommon clinical presentation. This was the case of a 67-year-old female with type 2 diabetes hospitalized for the exploration and management of severe and recurrent hypoglycemia. Her diabetes has been evolving since the age of 40 years and was complicated by minimal retinopathy. She was on premixed human insulin, administered through an insulin syringe for the last 17 years. She presented a history of well-controlled diabetes until five months back when she started to show a fluctuating blood glucose concentration, with episodes of unpredictable hypoglycemia occurring at variable times, with values inferior to 0.3 g/l associated with neurological features. Clinical examination revealed a swelling localized in the hypogastric region of the abdomen. It was painless, firm, not fixed to the underlying plans, without local inflammatory signs, and had appeared in the patient's preferred insulin injection site. Thus, we retained the diagnosis of insulin-induced lipohypertrophy. The patient has reported reusing needles for up to one week for economic reasons, and not frequently rotating insulin injection sites. The patient found a less painful injection in the lipohypertrophic area, and she continued to inject insulin into that zone, leading to its progressive enlargement. Therapeutic management consisted of switching the patient to insulin analogs and resuming education concerning the correct injection techniques. The insulin injection technique continues to be suboptimal in many insulin-treated patients, and our case emphasizes the need for improved awareness and education.

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