Insulin edema, a little known entity

Insulin edema is an entity that should be considered in any patient who starts or intensifies an insulin regimen to improve metabolic control. Heart, liver, and kidney problems should always be ruled out beforehand. The exact mechanism is not clear. It is usually self-limiting within a few days and rarely requires specific therapy. It could be prevented with a more progressive improvement in glycemic control avoiding rapid increases in insulin dose. We present the case of two female adolescents with a new diagnosis of type 1 diabetes mellitus with ketoacidosis. A few days after starting treatment with a basal bolus regimen with subcutaneous insulin, edema started and limited to the lower extremities. In both cases, the symptoms resolved spontaneously.