Three type I diabetic patients nonresponsive to subcutaneous
insulin were implanted with a subcutaneous peritoneal access device. In these patients, multiple
subcutaneous injections had been unable to prevent recurrent hospital admissions for
diabetic ketoacidosis. The patients were responsive to intravenous
insulin but had limited accessible peripheral veins. Complications of
thrombosis and/or
septicemia from permanent
central venous catheters prevented the long-term use of this route. The peritoneal access device was implanted subcutaneously adjacent to the umbilicus with its
insulin delivery
catheter terminating in the peritoneal space. Transcutaneous injection of
insulin into the subcutaneous access port resulted in the same quantity of
insulin entering the peritoneal space. Using a mixture of regular and
protamine zinc insulin in a ration of 1:1 resulted in acute increases in plasma free
insulin concentration with meals and a declining background level postprandially. All peritoneal access devices have been functioning well for at least 2 mo and in one of the implanted diabetic subjects, it has been in continuous use for 5 mo with no evidence of
peritonitis or resistance to peritoneal
insulin. These results suggest that a subcutaneous peritoneal access device may provide an alterative
insulin delivery route for patients who are nonresponsive to subcutaneous
insulin injections.