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Images in medicine
Distant site lipoatrophy: a rare complication of subcutaneous insulin therapy
  1. Partha Pratim Chakraborty,
  2. Sugata Narayan Biswas
  1. Department of Medicine, Midnapore Medical College & Hospital, Midnapore, West Bengal, India
  1. Correspondence to Dr Partha Pratim Chakraborty, Department of Medicine, Midnapore Medical College & Hospital, House No. BE 64; Bidhan Nagar (East), Midnapore 721101, West Bengal, India; docparthapc{at}yahoo.co.in

http://dx.doi.org/10.1136/postgradmedj-2015-133639

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    Introduction

    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.

    Case history

    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 …

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    Footnotes

    • Contributors PPC was involved in managing the patient and in the literature search and preparation of the manuscript. SNB was involved in the literature search and the preparation of the manuscript.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.