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Injection site lipodystrophy is not uncommon in insulin-treated patients with diabetes. In this era of human insulin and insulin analogues, lipoatrophy is far less common than lipohypertrophy, and distant site lipoatrophy is even rarer. The underlying pathophysiology of distant site lipoatrophy is largely undefined, and this disease is a diagnostic and therapeutic challenge to the treating physicians.
A 60-year-old woman (BMI 32 kg/m2) with a 25-year history of type 2 diabetes mellitus presented with a depression in her interscapular region that had been present for 3 months and was causing a significant visible cosmetic defect (figure 1). Due to a diminished response to oral drugs, the patient had been prescribed a twice daily premixed human insulin regimen (30% regular …