2015 Volume 58 Issue 1 Pages 34-40
A 62-year-old man with a 32-year history of type 1 diabetes mellitus was admitted to our hospital for surgery to treat a diabetic foot ulcer. Although he demonstrated good wound healing, his glycemic control deteriorated. Despite increasing the dose of insulin, the patient's blood glucose concentration remained high. On a physical examination, we found subcutaneous nodules on both sides of his lower abdomen at sites of repeated insulin injections. The nodules were examined histologically and immunohistochemically and considered to be due to localized insulin-derived amyloidosis. After changing the injection sites, his glycemic control significantly improved. The present case emphasizes the need for patient education regarding insulin self-injection. In addition, physicians should consider the possibility of local amyloidosis in patients with poor glycemic control.
