Abstract
We have experienced two patients with diabetic ketosis and insulin edema that developed following insulin treatment.
A 35-year-old female was admitted to our hospital with diabetic ketosis. She was given sebcutaneous injection of 30 units of regular insulin and 1, 000 ml of intravenous fluid daily. After three days, she noticed edema on the legs and the face. After 10 days, there was definite edema not only of the legs and the face, but also of other parts of the body. Her chest x-ray showed effusion in the left lower lung field and left interlobar space. Her weght increased by 17.5kg in 10 days of treatment. Edema, however, disappeared rapidly when 1 mg of bumetanide was given for two days.
A 49-year-old female was admitted with diabetic ketosis. She was given subcutaneous injection of 30 units of regular insulin and 500 ml of intravenous fluid daily. After six days, she noticed edema on the legs and the face. The edema became generalized in 10 days, and her chest x-ray showed effusion in the right lower lung field. Her weight increased by 7 kg in 10 days of treatment. Her diabetes was well controlled on 30 units of regular insulin daily, and edema disappeared as the insulin dose was reduced. Twelve days after discontinuing insulin treatment, her weight was down to 50 kg which was almost the same as her weight on admission (49kg).
In the two cases presented herein, renal function so far as PSP is concerned was normal, and edema disappeared when insulin dose was reduced and diuretics were administered. Such great retention of fluid is usually observed in type 1 diabetic patients and may result from a sudden reduction of the larger quantities of blood glucose using insulin.
In our two cases, hypoproteinemia which was also regarded as one of the possible causes, was present.
