|ISSN No. 1606-7754 Vol.8 No.2 August 2000|
Lispro insulin for the treatment fo severe subcutaneous insulin resistance
Vandistel G, Bex M, Mathieu C
Department of Endocrinology, UZ Gasthuisberg Katholieke Universitett Leuven Herestraat 49,3000 Leuven
Objective - To evaluate the clinical usefulness of the short-acting insulin analogue lispro in continuous subcutaneous insulin infusion (CSII) in type 1 patients with brittle diabetes due to severe subcutaneous insulin resistance who would otherwise require treatment with alternative insulin delivery systems (eg. by intraperitoneal insulin pump) necessary to prevent recurrent diabetic ketoacidosis.
Research design and methods - We proceeded in three patients with severe subcutaneous insulin resistance with a subcutaneous bolus test comparing the effects on plasma insulin levels and glycaemia of 15-30 U of regular insulin versus the same amount of lispro insulin. The successful bolus test prompted us to use lispro insulin in CSII in these patients. Adaptation of the insulin dose was made on the basis of daily capillary blood glucose measurements.
Results - In all patients lispro insulin was started in CSII (H-tron pump at 44 U/day) initially resulting in an improved metabolic control as reflected by acceptable blood glucose levels and by the HBA1c levels that dropped from 11 +/- 1% before to 7.9 +/- 1% during lispro treatment. During the following 8 weeks a progressive rise in blood glucose levels and rise in HbA1c levels to 10.3 +/- 0.1% was seen with consequently insulin dose adjustment to more than 500 U/day. Finally in all patients further insulin delivery by an intraperitoneal pump was required. Conclusions - In three patients with subcutaneous insulin resistance the administration of subcutaneous lispro insulin resulted in acceptable metabolic control, but progressively all three patients developed a resistance syndrome against subcutaneous lispro insulin completely comparable to the resistance syndrome against subcutaneous regular insulin. Subcutaneous treatment with the insulin analogue therefore seems to overcome the problem of insulin resistance only temporarily.
Key words: Insulin analogue lispro - subcutaneous insulin resistance - brittle diabetes