title: 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.affiliation: University Diabetes Treatment Center/Parkland Memorial Hospital, Dallas, Texas.
authors.forename: P F
authors.initials: PF
authors.lastname: Mora
authors.forename: L C
authors.initials: LC
authors.lastname: Ramirez
authors.forename: D
authors.initials: D
authors.lastname: Lender
authors.forename: P
authors.initials: P
authors.lastname: Raskin
mesh_terms: D000052:Acanthosis Nigricans / Q000150:complications; D000208:Acute Disease; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004435:Eating; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications; D007328:Insulin / Q000627:therapeutic use*; D008060:Lipodystrophy / Q000150:complications*; D010195:Pancreatitis / Q000209:etiology / Q000628:therapy*; D010289:Parenteral Nutrition, Total
chemical_list: D001786:Blood Glucose; D007328:Insulin