A Case of Probable Subcutaneous Insulin Resistance in Slowly Progressive Type 1 Diabetes

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  • 高齢者緩徐進行1型糖尿病（SPIDDM）患者におけるsubcutaneous insulin resistanceが疑われた1例
  • ショウレイ ホウコク コウレイシャ カンジョ シンコウ 1ガタ トウニョウビョウ(SPIDDM)カンジャ ニ オケル subcutaneous insulin resistance ガ ウタガワレタ 1レイ

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Abstract

A 74-year-old woman was diagnosed as having slowly progressive type 1 diabetes at age 67, and treated with insulin at that time, but the dose of insulin was gradually increased. She was admitted to our hospital because of poor glycemic control (HbA1c (JDS) 8.7 %) ) and postprandial hypoglycemia, despite the large amounts of insulin (98 units/day). With the reduction of her body weight, the required dose of insulin was decreased, but fasting hyperglycemia persisted and hypoglycemia still occurred after meals. We replaced the basal insulin one by one with insulin detemir (34 units/day), intermediate-acting insulin lispro (30 units/day), or insulin lispro (16.8 units/day) with continuous subcutaneous insulin infusion (CSII). CSII (lispro) maintained better glycemic control compared with insulin detemir. Therefore, we examined the blood glucose level and blood insulin lispro concentration and compared them between CSII (lispro) administration and single subcutaneous injection of intermediate-acting insulin lispro. CSII (lispro) made it possible to obtain higher blood insulin lispro levels even in smaller amounts, and also improved blood glucose level compared with the intermediating-acting type. These findings indicate that even when the structure of insulin is the same, an insulin formulation which remained longer under the skin had difficulty in entering the bloodstream, suggesting that insulin absorption was prevented in the subcutaneous tissue in this patient.<br>

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