Clinical Snapshot
Severe Diabetic Ketoacidosis Associated with Abdominal Lipohypertrophy
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A 23-year-old socially deprived man with a 15-year history of type 1 diabetes was brought to our hospital after becoming somnolent and dehydrated with a blood glucose concentration of 885 mg/dL. Arterial blood gas analysis (pH 7.05, bicarbonate 8.8 mmol/L) and the presence of massive ketonuria confirmed the diagnosis of severe ketoacidosis. The patient’s metabolism was chronically decompensated (HbA1c 18.7%), and he hardly ever measured his blood glucose concentration. He always injected his insulin into a large abdominal lipohypertrophy (Figure). Careful inspection and palpation identify lipohypertrophies in 20 to 40% of persons who inject themselves with insulin. These swellings (or hardenings) of the subcutaneous fatty tissue make it impossible to calculate insulin absorption, thus risking hyperglycemia or hypoglycemia. Constant injection of insulin at the same site and microtrauma from the re-use of pen needles are predisposing factors. Mediated by insulin-like growth factor 1, insulin also stimulates growth at the local level. Lipohypertrophies are often reversible if local insulin injection is strictly avoided, and can be prevented by adherence to correct injection technique with systematic variation of sites. After initial intensive care, our patient received detailed diabetes training with a considerable reduction in insulin dose. He was discharged to outpatient diabetological care.
Prof. Dr. med. Andreas Holstein, Milena Gehrig, Dr. med. (univ.) David J.F. Holstein, Medizinische Klinik I, Klinikum Lippe-Detmold, Detmold,
Andreas.Holstein@klinikum-lippe.de
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare.
Cite this as: Holstein A, Gehrig M, Holstein DJF: Severe diabetic ketoacidosis associated with abdominal lipohypertrophy.
Dtsch Arztebl Int 2021; 118: 682. DOI: 10.3238/arztebl.m2021.0074
