[Insulin edema about 3 cases]

Insulin edema is known since a long time as a rare complication of insulin therapy. However, even today its pathogenesis remains unclear. Possible mechanisms involved are increased sodium retention by the kidney [2, 3] and increased loss of albumin from the circulation because of an insulin-induced increase in vascular permeability. We report three cases of adult patients, which presented with edema under insulin treatment. The first observation is a 52-year-old woman with diagnosed diabetes for 1 year, who developed edema a few days after initiation of insulin treatment [0, 9 Ul/kg/d]. The second observation is a 54-year-old woman who developed, ten years after initiation of insulin, generalized edema and two episods of cardiac failure, The third observation is a 42-year-old woman with type 1 diabetes since she was 20 years old. She presented an edema 20 years after the beginning of insulin treatment. In the two first cases, the stopping of insulin treatment resulted in resolution of edema. In the third one, any another cause of edema had been found. Insulin edema is a rare complication that always must be kept in mind, even after a long period of insulin treatment. In almost all the cases, it is not clinically evident. However, it sometimes leads to severe complications like cerebral edema or cardiac failure. A precocious diuretic treatment may prevent those complications

[Hyperlipemia and lymphoma]

While the concept of developing hypocholesterolemia during myeloma or lymphoma is not unusual, the existence of developing hyperlipemia is rare. The authors report the case of a sixty-one year old diabetic patient treated by oral medication. This patient does not have a family history of hyperlipemia. He was hospitalized for degradation of his general condition, and a pain of the right shoulder and bilateral pleural effusion. A major hyperlipidemia [total cholesterol = 13.5 mmol/l, triglycerides = 16.8 mmol/l] was noted during his hospitalization and persisted in spite of a fibrate treatment and a controlled diabetes. The radiography of the upper right limb showed lytic images of the extremity of the humerus. The thoracic CT scan showed bilateral pleural effusion and a hyperdense paravertebral image of ganglion metastasis. The myelograme and the pleural biopsies showed a malignant non hodgkin lymphoma. An immunosuppressor treatment was prescribed resulting in a spectacular improvement of the hyperlipidemia since the first chemotherapy. This is probably an autoimmune hyperlipidemia associated with a lymphoma. Further investigations like the study of the lipoprotein lipase activity, the search of antibodies related to the apo E or the apo B would be useful in order to confirm this assumption