Can Insulin Cause Swelling? Insulin Edema Explained
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[Answers · Diabetes medicines and insulin]

Can insulin cause swelling?

From FDA labels, public health agencies and published studies · Reviewed

Short answer: It can. The Humalog, NovoLog and Lantus labels say insulin may cause sodium retention and swelling (edema), particularly when blood sugar that was poorly controlled improves with more intensive insulin treatment. A 2004 review calls widespread insulin edema rare and usually self-limiting. Swelling can also come from injection site reactions, from other medicines such as pioglitazone, or from heart, kidney or liver problems.

What the insulin labels say

The Humalog and NovoLog labels say insulins may cause sodium retention and edema, particularly if previously poor blood sugar control is improved by intensified insulin therapy. The Lantus label says some people taking it have had sodium retention and edema in the same situation, and lists edema among its commonly associated reactions along with weight gain.

The Lantus label also reports a 5-year study in adults with type 2 diabetes that compared Lantus with NPH insulin. Peripheral edema (swelling of the legs, ankles or feet) was reported in 20.0% on Lantus and 22.7% on NPH. There was no placebo group, so the study shows that leg swelling was common in this group of adults on insulin over 5 years, but not how much of it insulin caused.

Insulin edema

A 2004 review in the Journal of Investigative Medicine describes generalized insulin edema as rare but well recognized. It is mainly seen in people with newly diagnosed or poorly controlled diabetes after starting intensive insulin therapy. The review calls it self-limiting, but notes reports of it progressing to heart failure and fluid around the lungs, and says it should be told apart from other causes of swelling.

Because it usually appears soon after insulin is started or increased, the timing is part of what a clinician looks at. New swelling with shortness of breath, rapid weight gain or chest symptoms needs prompt medical attention whatever the cause.

Other causes to rule out

  • Injection site reactions. The labels list redness, swelling and itching at the injection site as local allergic reactions.
  • Severe allergy. The labels warn that rare whole-body allergic reactions can include swelling of the face and throat (angioedema), which is an emergency.
  • Other diabetes medicines. Pioglitazone and other thiazolidinediones can cause fluid retention, and their combination with insulin carries a heart failure warning (see pioglitazone with insulin).
  • Other causes in MedlinePlus. Its leg swelling page lists being overweight, vein problems, blood clots, long periods of sitting or standing, heart, kidney or liver failure, and medicines such as calcium channel blockers, NSAIDs, steroids, estrogen and testosterone.

What to note for the prescriber

Useful details are when the swelling started, whether insulin was started or increased around then, which other medicines changed, and daily weight. Dose Track can log insulin doses with notes and weight on the same timeline, so the pattern is easy to show at the next visit.

Read more on Dose Track: Edema · Lantus side effects · NovoLog side effects · Humalog side effects

General education drawn from labels, public health agencies and published studies, not personal medical advice. Your prescriber, pharmacist and the label that came with your medicine are the final word. Questions for other users? Ask in the Dose Track community.
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Frequently asked questions

What is insulin edema?+
Swelling from sodium and fluid retention after insulin is started or increased, mostly when blood sugar had been poorly controlled. A 2004 review calls the widespread form rare and usually self-limiting.
Does Lantus cause leg swelling?+
The Lantus label lists edema among its commonly associated reactions. In a 5-year study, leg swelling was reported in 20.0% on Lantus and 22.7% on NPH insulin.
Does insulin swelling go away?+
The 2004 review describes insulin edema as self-limiting, but reports of heart failure exist, so new swelling is worth raising with the prescriber.

Sources

  1. Humalog (insulin lispro) US prescribing information, DailyMed
  2. NovoLog (insulin aspart) US prescribing information, DailyMed
  3. Lantus (insulin glargine) US prescribing information, DailyMed
  4. Chelliah and Burge. J Investig Med 2004 (insulin edema in the twenty-first century: review of the existing literature). PMID 15068225
  5. MedlinePlus: Foot, leg, and ankle swelling

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