Complications of Insulin Therapy
Short Answer
Local Allergic Reactions - redness, swelling, tenderness and induration or 2-4 cm wheal. disappear with continued use of insulin - rare with human insulin - antihistamine one hr before insulin
Systemic Allergic Reactions - rare - local skin reaction spreads into generalized urticaria - treatment: desensitization using a desensitization kit.
Insulin Lipodystrophy - lipoatrophy/lipohypertrophy - use of human insulin has almost eliminated this - rotation of injection sites practised
Insulin Resistance - daily insulin requirements of 200 units or more - treat with more concentrated insulin preparation - U500 - occasionally prednisone is needed.
Somogyi effect - (dawn phenomenon) - nocturnal hypoglycemia followed by rebound hyperglycemia - prevented by having the dose of NPH insulin to bed time instead of just before dinner.
Insulin coma
Patient goes in for hypoglycemia and coma mainly due to skippping of diet at dinner time. It usually sets in the early morning at about 2 am to 5 am. Treat with 25% Dextrose bolus IV. If needed 2 ampouls.
Hypoglycemia (abnormally low blood glucose level) occurs whenthe blood glucose falls to less than 50 to 60 mg/dL (2.7 to 3.3 mmol/L). It can be caused by too much insulin or oral hypo-glycemic agents, too little food, or excessive physical activity. Hy-poglycemia may occur at any time of the day or night. It oftenoccurs before meals, especially if meals are delayed or snacks are omitted. For example, midmorning hypoglycemia may occur when the morning regular insulin is peaking, whereas hypo-glycemia that occurs in the late afternoon coincides with the peak of the morning NPH or Lente insulin. Middle-of-the-night hypo-glycemia may occur because of peaking evening or predinner
NPH or Lente insulins, especially in patients who have not eaten a bedtime snack.
