Anxiety and Body Image Distress in a Type 1 Diabetes Patient With Insulin-Induced Lipodystrophy

This case report presents a rare instance of a 28-year-old female patient with insulin-induced abdominal lipodystrophy, who presented to the emergency department with symptoms of an anxiety attack triggered by body image distress. She was diagnosed with type 1 diabetes at the age of eight years. For the past 10 years, she has been using insulin glargine and insulin lispro, injecting roughly five times per day. The patient knew the importance of the need to rotate injection sites and injection techniques. She mentioned that she changed her insulin needles every two weeks because she was lazy about it. She also mentioned that she used 4 mm 32G pen needles. Her diabetes was well-controlled, with glycated hemoglobin (HbA1c) levels of 6.5%. Clinical examination revealed a soft swelling with striae on the abdomen (hypogastrium and left iliac fossa). The patient reported repeated insulin injections, both rapid-acting and long-acting, in the same lipodystrophic region because it was less painful and provided easier access to the injection site in public. The patient was known to the emergency department staff due to her repeated visits with symptoms of anxiety. Lipodystrophy is a condition characterized by abnormal fat distribution at insulin injection sites. Insulin-induced lipodystrophy is a known complication of long-term insulin therapy, often leading to local adiposity, metabolic disturbances, and psychological challenges. The report underscores the importance of considering psychological aspects when managing patients with acquired lipodystrophy, highlighting the relationship between fat redistribution and depression in this patient population, who are already at increased risk of mood disorders.