Complications of insulin treatment
- Hypoglycaemia (low blood sugar level) (Ch.13)
Allergy
Local reactions like urticaria, small lump under the skin within 30 minutes of insulin injection or generalized reaction like rash, itching or rarely even shock, seen with older bovine insulin preparations have now become extremely rare with the introduction of pork and human insulin.
Scarring of tissue under the skin
The skin and the underlying tissue get thickened and scarred if insulin is injected repeatedly at the same site.
Shrinking of fat under the skin
Sometimes, the fat tissue under the skin may shrink at the injection sites, giving rise to hollows over the arms, thighs or abdomen. Such hollows may also develop away from the injection sites. This shrinking of fat tissue does not involve any underlying important structure like a blood vessel or a nerve and is of cosmetic importance only. The hollows gradually fill up with the passage of time. Insulin may be injected in the edges of the hollows. Women should avoid injecting conventional insulin in the arms because of likelihood of this complication. This problem is very rare with purified and
Lumps of fat
Sometimes, lumps of fat develop at the site of injection. This happens more often in those who inject insulin in same site and is prevented by rotating the injection site. Insulin is not absorbed properly when injected into these fat lumps. Small fat lumps may resolve if insulin is not into these lumps for some time. Liposuction is useful if the fat lump is unsightedly. Insulin should not be injected into these lumps. The use of purified insulin is not attended with this complication.
Abscess
This complication is rare because the preservative added to insulin has antibacterial properties.
Blurring of vision
During the initial period of insulin treatment, a diabetic may notice blurring of vision and difficulty in reading. This complaint is due to a rapid change in the shape of the lens of the eye as the elevated blood glucose level is brought down. The shape of lens gets adjusted within two to three weeks. Hence a diabetic should not change his glasses, in a hurry, if he/she develops this complication.
Weight gain
Weight gain when diabetes is controlled by insulin is inevitable. This is due to rebuilding of depleted muscle and fat mass, cessation of loss of energy in the form of glucose in urine and correction of dehyration. Extra carbohydrates consumed to prevent hypoglycaemia, contribute to this weight gain (Ch.13). The snacks taken in between the main meals, to prevent hypoglycaemia, should be reckoned in the diet. Metformin, helps to check weight gain associated with insulin treatment. (Ch. 9)
Swelling of the face and/or feet
At the start of treatment, of poorly controlled diabetes with insulin, the patient may get swelling of face and/or feet, due to retention of sodium and water. This complication is temporary and passes in a few days. The doctor may give the diabetic a small dose of diuretic (a drug which increases the urine) or ephedrine if this swelling is significant.
Insulin Antibodies
Nearly all persons who receive insulin develop antibodies to it. This tendency to produce antibodies is less with regular insulin than with either NPH or lente insulin, is !ess with lente insulin than with NPH insulin and less with pork insulin than with bovine insulin. It is the least with highly purified insulins, especially pork or human insulin. Surprisingly, antibodies may develop even with human insulin and its analogues. Some problems, like allergy and resistance to insulin are due to the development of antibodies to insulin. Rarely, insulin antibodies may develop spontaneously.
SPECIAL INSULIN SYRINGES