• Terumasa Nagase, Keiichi Iwaya, Yoshiki Iwaki, Fumio Kotake, Ryuji Uchida, Tsunao Oh-i, Hidenori Sekine, Kazuhiro Miwa, Satoshi Murakami, Tomotada Odaka, Masahiko Kure, Yoko Nemoto, Masayuki Noritake, and Yoshiya Katsura.
• Department of Metabolism and Endocrinology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan. Electronic address: tnagase@tokyo-med.ac.jp.
• Am. J. Med. 2014 May 1; 127 (5): 450454450-4.

ObjectivesInsulin-derived amyloidosis is a rare skin-related complication of insulin therapy. The purpose of this study was to show the effects of insulin-derived amyloidosis on blood glucose levels, insulin dose requirements, and insulin absorption.MethodsSeven patients were found to have insulin-derived amyloidosis at the Tokyo Medical University Ibaraki Medical Center. The clinical characteristics and insulin therapy of the 7 patients were investigated. Insulin absorption was studied by comparing the serum insulin levels after insulin injections into insulin-derived amyloidosis sites versus injections into normal sites in 4 patients.ResultsWhen the insulin-derived amyloidosis was discovered, the mean hemoglobin A1c level was 9.3%, and the mean daily insulin dose was 57 units. After changing the injection sites to avoid the insulin-derived amyloidosis, the blood glucose concentrations improved, and the mean daily insulin dose could be reduced to 27 units (P = .035; 53% reduction). The insulin absorption at insulin-derived amyloidosis sites was 34% of that at normal sites (P = .030).ConclusionsInsulin-derived amyloidosis caused poor glycemic control and increased insulin dose requirements because of impairments in insulin absorption.Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

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