Virginia Research Day 2022

Medical Resident Research Case Reports

01 Recurrent Hypoglycemia After Diagnosis And Treatment Of Insulin-Derived Amyloidosis

Aaron Estep, DO; Jarrod Uhrig, DO; Curtis Bower, MD; Robert Jarrett, MD Corresponding author adestep@carilionclinic.org

Department of Family Medicine, Carilion Clinic Virginia Tech Carilion Family Medicine Residency

frequent hypoglycemia likely due to improved insulin absorption and action in unaffected tissue. This case demonstrates the importance of recognizing this rare complication from subcutaneous insulin, counseling patients using insulin about frequent rotation of injection sites, and the potential risk of hypoglycemia after patients rotate injection locations.

cessation of injections in the affected areas and can lead to more disruption of insulin absorption. We present a case of a 57-year-old female who developed a firm abdominal mass in the region of repeated insulin injections over at least 15 years. Imaging was inconclusive and she eventually had surgical excision of the mass with pathologic evidence of amyloid deposition in the tissue consistent with insulin-derived amyloidosis. After the surgery, she required multiple reductions in insulin dose due to

Insulin-derived amyloidosis is a rare complication from long-term subcutaneous insulin delivery. Although it is not well- represented in literature, it is typically described as a firm mass in areas of repeated insulin injections over years. The mass can grow over time and limit absorption and action of insulin. Because of this, rotating injection sites away from this area or removing the mass can lead to profound hypoglycemia. Although there is overlap between lipohypertrophy and insulin-derived amyloidosis, insulin-derived amyloidosis will typically not regress with

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