Dexamethasone Halts Rare Complication of Type 1 Diabetes

A new treatment method has been discovered for lipoatrophy, a rare but problematic complication of type 1 diabetes. The condition is an adverse effect of the immune system’s interaction with insulin that results in dents in the skin at insulin injection sites. These dents are caused by atrophy of the tissue directly beneath the skin.

Insulin is known to produce allergic and immunological reactions in some people. In such a reaction, the body’s immune system attacks the foreign substance, like it would a disease-causing bacteria.

Lipoatrophy is an example of this type of immune system response. It includes the production of cytokines, proteins that work as mediators between the cells in the “infected” area and help generate the response.

In a study published in the November 1996 issue of Diabetes Care researchers hypothesized that the cytokines might also cause the tissue atrophy at injection sites. In laboratory experiments researchers found that dexamethasone, an anti-inflammatory medication, inhibited the production of cytokines.

After these laboratory findings, dexamethasone was used on a 25-year-old woman with lipoatrophy on her arms, abdomen and hips. A mixture of insulin and dexamethasone was injected directly into her lipoatrophic injection sites. This treatment had no effect on the patient’s metabolic control and her daily insulin requirements did not change. After 12 months of treatment, all of her lipoatrophic areas disappeared.