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Long‐term Use of Intramuscular Insulin Therapy in a Type I Diabetic Patient with Subcutaneous Insulin Resistance
Author(s) -
Brossard J.H.,
Havrankova J.,
Rioux D.,
Bertrand S.,
D'Amour P.
Publication year - 1993
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.1993.tb00037.x
Subject(s) - medicine , insulin , ketoacidosis , insulin resistance , regular insulin , diabetic ketoacidosis , endocrinology , diabetes mellitus , intramuscular injection , nph insulin , type 2 diabetes , subcutaneous injection , type 1 diabetes , hypoglycemia , insulin glargine
We studied a 26‐year‐old Type 1 diabetic patient who experienced recurrent episodes of ketoacidosis and who was unresponsive to subcutaneous insulin, but normally responsive to intravenous insulin as demonstrated by insulin challenge test. Attempts at intravenous and intraperitoneal insulin administration were complicated by recurrent septicaemia. We therefore investigated the hypoglycaemic effect of intramuscular insulin administration in this patient. After intramuscular injection of NPH and Ultralente human insulin (0.1 U kg −1 ), the lowest plasma glucose levels occurred 1 and 7h later, respectively; the hypoglycaemic effect lasted approximately 2 and 12 h, respectively. We based insulin therapy on intramuscular NPH as a fast‐acting insulin and Ultralente as an intermediate‐acting insulin using four injections a day. During the next 24 months, the patient was hospitalized for 4 weeks versus 56 weeks in the 20 months preceding intramuscular insulin administration, and was able to resume full‐time work. HbA 1c decreased from 11.7 % to 8.7 % (normal range: 4.2–5.9 %). Thus, long‐term intramuscular insulin therapy is a feasible alternative to intravenous or intraperitoneal insulin in patients with well‐demonstrated resistance to subcutaneous insulin.