Extreme Subcutaneous Insulin Resistance Successfully Treated by an Implantable Pump
- Jean-Pierre Riveline, MD1,
- Jacqueline Capeau, MD, PHD2,
- Jean-Jacques Robert, MD, PHD3,
- Michel Varroud-Vial, MD1,
- Isabelle Cerf-Baron, MD1,
- Anne Deburge, MD1 and
- Guillaume Charpentier, MD1
- 1Service d’Endocrino-Diabétologie, Centre Hospitalier Sud-Francilien, Corbeil, France
- 2Institut National de la Santé et de la Recherche Médicale, Faculté de Médecine, Saint-Antoine, France
- 3Hôpital Necker-Enfants Malades, Paris, France
Extreme subcutaneous insulin resistance is a very rare syndrome characterized by severe resistance to subcutaneous insulin together with normal or near normal intravenous insulin sensitivity. The pathophysiology is unknown. An increased insulin-degrading activity has been reported in the subcutaneous adipose tissue fraction (1). The proposed treatments are disappointing. We report such a case that was successfully treated by intraperitoneal insulin.
A 36-year-old male patient was admitted for acute pancreatitis of unknown etiology associated with diabetes. His mother had type 2 diabetes. The patient’s BMI was 31 kg/m2. After the onset of acute pancreatitis, the patient discontinued his antidiabetic treatment. Five years later, he was admitted in a hyperosmolar state (fasting blood glucose of 1,000 mg/dl) without ketoacidosis. His BMI was 28 kg/m2. Subcutaneous insulin was resumed, using multi-injections, followed by subcutaneous treatment with an insulin pump. Despite a dramatic increase in the insulin …
