Oedema Associated With Improved Glycaemic Control in a 15-Year-Old Nigerian Girl With Type 1 Diabetes Mellitus Complicated by Ketoacidosis

Introduction

Insulin-induced oedema is a recognised but uncommon complication of insulin therapy especially in the paediatric age group (16 years and below).¹ At present, the pathogenesis is poorly understood and its epidemiology is unknown. It affects mainly patients with newly diagnosed type 1 diabetes mellitus or patients with poorly controlled diabetes mellitus after starting intensive insulin therapy or grossly underweight patients on large doses of insulin.^2,3 It has also been reported in patients with diabetic ketoacidosis.^4,5 Its clinical presentation is quiet variable ranging from mild peripheral oedema to cardiac failure and massive serosal effusions.⁶ DeFronzo et al. ^7–9 have attempted to clarify its underlying pathophysiological mechanism by demonstrating insulin-induced anti-natriuresis in man. Insulin-induced oedema is usually self-limiting but may occasionally progress to overt cardiac failure and development of pleural effusion.² Sometimes, too, the oedema may be gradually replaced by fat tissue with persistent weight gain.¹⁰

Abstract

In this article, we reported a recent case of a 15-year-old grossly underweight ( weighed 29 kg) Nigerian girl diagnosed of type 1 diabetes mellitus 4 years ago and who defaulted from follow-up but presented with diabetic ketoacidosis. Her glycaemic control was poor because of poor compliance. Following treatment with insulin infusion, she developed facial swelling on the fifth day of admission, followed by pitting ankle and pretibial oedema two days later. The natural history of insulin-induced oedema was observed in this patient because the oedema resolved 7 days later without any specific therapy, such as administration of diuretics. The aim of this article was to review existing medical literature on the subject of insulin-induced oedema and raise the awareness of clinicians of the occurrence of oedema as an uncommon complication of insulin therapy. In conclusion, insulin-induced oedema should be considered in the differential diagnosis of oedema in children and adolescents with type 1 diabetes mellitus.

Keywords

Insulin therapy, oedema, childhood diabetes mellitus, Nigeria