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Insulin-mediated lipohypertrophy: an uncommon cause of diabetic ketoacidosis
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  1. Anjana Barola1,
  2. Pramil Tiwari1,
  3. Anil Bhansali2
  1. 1 Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar (Mohali), Punjab, India
  2. 2 Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Dr Anil Bhansali, anilbhansaliendocrine{at}gmail.com

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Description

A 15-year-old boy with a 3-year history of type 1 diabetes mellitus was referred to endocrinology clinic for the management of uncontrolled blood glucose levels. His present treatment plan comprised subcutaneous basal-bolus insulin regimen. He was taking regular insulin before the three major meals and insulin glargine at the bedtime. His body mass index (BMI) was 14.8 kg/m2 and HbA1c level 14.9%, suggesting uncontrolled hyperglycaemia for a long time.

On examination, he was found to have remarkably prominent bilateral lipohypertrophic areas on the lower abdomen (figure 1), large enough to be noticeable even through the clothing.

Figure 1

Showing prominent bulge on either side of the lower abdomen (side view).

His injection practices revealed …

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