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Insulin Requirements in Lipodystrophic Diabetes
Author(s) -
Mora P.F.,
Ramirez L.C.,
Lender D.,
Raskin 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.tb00181.x
Subject(s) - medicine , lipodystrophy , insulin , hypermetabolism , diabetes mellitus , acute pancreatitis , endocrinology , pancreatitis , parenteral nutrition , acanthosis nigricans , regular insulin , insulin resistance , hypoglycemia , human immunodeficiency virus (hiv) , family medicine , viral load , antiretroviral therapy
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.