Insulin administration to an abdominal insulin ball that triggered the onset of diabetic ketoacidosis accompanied by Hamman’s syndrome in a patient with type 1 diabetes mellitus
A 41-year-old man with type 1 diabetes mellitus was referred to our hospital because of diabetic ketoacidosis accompanied by Hamman’s syndrome. Recently, he has injected a total of 68 units of lispro and 50 units of degludec. Although he didn’t notice at all, there was a huge subcutaneous induration on the left abdomen. We diagnosed this as an insulin ball. It is noted here that insulin injection site had been fixed for 19 years. After resuming insulin injection while avoiding the insulin ball, good glycemic control was obtained only with 31 units of aspart and 17 units of degludec.
