Insulin Pump-Induced Lipoatrophy: Proposed Diagnostic and Management Algorithm.

Lipoatrophy, the localized loss of subcutaneous fat, is a rare complication of insulin therapy that persists despite advancements in insulin formulations and delivery systems. This case report describes a 58-year-old woman with type 1 diabetes mellitus who developed considerable abdominal wall lipoatrophy 4 months after initiating insulin pump therapy. Management included changing the infusion cannula type, rotating insertion sites, and switching insulin analogues, resulting in stabilization and complete improvement of lipoatrophy over 16 months. A diagnostic and management algorithm is proposed, incorporating site rotation, cannula and insulin type modifications, and potential adjunctive therapies including topical sodium cromoglycate and corticosteroids.