Insulin requirements in lipodystrophic diabetes.

Abstract

A ten-fold increase in daily insulin requirements during the administration of total parenteral nutrition (TPN) is described in a patient with congenital generalized lipodystrophy, insulin-requiring diabetes mellitus, and acanthosis nigricans during an episode of acute pancreatitis secondary to hypertriglyceridaemia. After a period of 13 days on TPN, insulin requirements increased dramatically to an average of 1428 units per day for a period of 12 days, to achieve a mean blood glucose level of 10.9 mmol l-1. When the patient resumed feeding and the TPN was discontinued, the average daily insulin requirement was 104 units with a mean 24 h blood glucose of 11.8 mmol l-1. Parenteral administration of energy substrates in a rare case of diabetes mellitus and congenital lipodystrophy complicated by acute pancreatitis resulted in a severe insulin insensitive state due to the combination of the hypermetabolism conferred by the pancreatitis plus transient impairments of the glucose disposal mechanism by the energy substrates provided.

• Authors: P F Mora, L C Ramirez, D Lender, P Raskin
• Journal: Diabetic medicine : a journal of the British Diabetic Association (Diabet Med) Vol. 10 Issue 9 Pg. 863-5 (Nov 1993) ISSN: 0742-3071 [Print] England
• PMID: 8281734 (Publication Type: Case Reports, Journal Article)

Chemical References

• Blood Glucose
• Insulin

Topics

• Acanthosis Nigricans (complications)
• Acute Disease
• Adult
• Blood Glucose (metabolism)
• Diabetes Mellitus, Type 1 (blood, complications, drug therapy)
• Dose-Response Relationship, Drug
• Eating
• Female
• Humans
• Hypertriglyceridemia (complications)
• Insulin (therapeutic use)
• Lipodystrophy (complications)
• Pancreatitis (etiology, therapy)
• Parenteral Nutrition, Total