Insulin-Derived Amyloidosis

This case report describes a 47 year old man with type 2 diabetes who developed pendulous skin masses on his lower abdominal wall due to repeated insulin injections. The lesions, initially suspected to be lipohypertrophy, were histopathologically confirmed as insulin derived amyloidosis, characterized by amyloid deposits staining positive for Congo red (apple green birefringence) and thioflavin T. The patient experienced unpredictable hypoglycemia and elevated glycated hemoglobin (9.2%). After discontinuing injections into the masses and rotating sites, his insulin requirements decreased, and glycated hemoglobin improved to 7.5%. Surgical resection was performed for cosmesis, with no recurrence at 3-month follow up. The report highlights the importance of differentiating amyloidosis from lipohypertrophy and emphasizes injection site rotation for prevention.

This case report describes a 47 year old man with type 2 diabetes who developed pendulous skin masses on his lower abdominal wall due to repeated insulin injections. The lesions, initially suspected to be lipohypertrophy, were histopathologically confirmed as insulin derived amyloidosis, characterized by amyloid deposits staining positive for Congo red (apple green birefringence) and thioflavin T. The patient experienced unpredictable hypoglycemia and elevated glycated hemoglobin (9.2%). After discontinuing injections into the masses and rotating sites, his insulin requirements decreased, and glycated hemoglobin improved to 7.5%. Surgical resection was performed for cosmesis, with no recurrence at 3-month follow up. The report highlights the importance of differentiating amyloidosis from lipohypertrophy and emphasizes injection site rotation for prevention.