Successful Implementation of Perioperative Glycemic Control Following Pancreaticoduodenectomy in a Type 2 Diabetic Patient with a Zinc Allergy via the Continuous Subcutaneous Infusion of Insulin Glulisine

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  • Sakamoto Kenichi
    Department of Endocrinology and Metabolism, Toranomon Hospital
  • Nagasawa Kaoru
    Department of Endocrinology and Metabolism, Toranomon Hospital
  • Ishiguro Kimiko
    Department of Endocrinology and Metabolism, Toranomon Hospital
  • Nishimura Akihiro
    Department of Endocrinology and Metabolism, Toranomon Hospital
  • Okubo Minoru
    Department of Endocrinology and Metabolism, Toranomon Hospital
  • Yamashiro Keiko
    Department of Diabetes and Endocrinology, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine
  • Onuma Tomio
    Department of Diabetes and Endocrinology, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine
  • Mori Yasumichi
    Department of Endocrinology and Metabolism, Toranomon Hospital

Bibliographic Information

Other Title
  • 亜鉛アレルギーを有する2型糖尿病の膵臓癌周術期にグルリジンのCSIIを適応した1例
  • 症例報告 亜鉛アレルギーを有する2型糖尿病の膵臓癌周術期にグルリジンのCSⅡを適応した1例
  • ショウレイ ホウコク アエン アレルギー オ ユウスル 2ガタ トウニョウビョウ ノ スイゾウ ガン シュウジュツキ ニ グルリジン ノ CS Ⅱ オ テキオウ シタ 1レイ

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Description

We herein describe the case of a 63-year-old man with type 2 diabetes mellitus diagnosed eight years ago who developed a rash and hepatic dysfunction following the subcutaneous injection of insulin (i.e. insulin aspart, insulin lispro and regular human insulin). He was diagnosed with pancreatic cancer and admitted to our hospital for pancreaticoduodenectomy in May 2011. Despite the administration of oral hypoglycemic therapy, the patient's blood glucose control was poor (HbA1c: 8.5 %; non-fasting blood glucose: 355 mg/dl), which necessitated the inclusion of insulin in his perioperative blood glucose management regimen. The patient tested negative for insulin-specific IgE antibodies. Drug lymphocyte stimulation tests and intradermal skin tests for various types of insulin also yielded negative results. Subsequently, he tested positive on a zinc patch test, thus indicating that he had a zinc allergy. However, no allergic reactions were recorded following the administration of zinc-free insulin glulisine via continuous subcutaneous insulin infusion (CSII). This procedure proved efficacious in achieving perioperative glycemic control after pancreaticoduodenectomy. The findings of this case show that CSII treatment with insulin glulisine is very effective for obtaining perioperative glycemic control after pancreaticoduodenectomy in type 2 diabetes patients with zinc allergies.

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