title: Successful treatment of severe subcutaneous insulin resistance with inhaled insulin therapy.
abstract: The potential of inhaled insulin therapy for severe resistance to subcutaneous insulin was tested in a 7-yr old boy with type 1 diabetes mellitus. The efficiency of 1 mg inhaled insulin (Exubera) was examined by a 4-h euglycemic clamp study. During the clamp, the glucose infusion rate started to increase 25 min after inhalation and peaked 120 min after inhalation. Subsequently, a trial of inhaled insulin monotherapy was initiated consisting of pre-meal inhalations and one inhalation during the night. Since glycemic control remained fair (HbA1c approximately 8.5%), this therapy was continued. Over the ensuing 18 months, mild keto-acidosis occurred twice during gastro-enteritis. Inhaled insulin was well tolerated and pulmonary function did not deteriorate. We conclude that severe resistance to subcutaneous insulin does not preclude sufficient absorption of insulin delivered by pulmonary.
authors.affiliation: Metabolic and Endocrine Diseases at Department of Pediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands. j.vanalfen@cukz.umcn.nl
authors.forename: A A E M
authors.initials: AA
authors.lastname: van Alfen-van der Velden
authors.forename: C
authors.initials: C
authors.lastname: Noordam
authors.forename: B E
authors.initials: BE
authors.lastname: de Galan
authors.forename: J J G
authors.initials: JJ
authors.lastname: Hoorweg-Nijman
authors.forename: P G
authors.initials: PG
authors.lastname: Voorhoeve
authors.forename: C
authors.initials: C
authors.lastname: Westerlaken
mesh_terms: D000280:Administration, Inhalation; D001786:Blood Glucose; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D007333:Insulin Resistance; D008297:Male; D012141:Respiratory Tract Infections / Q000150:complications; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; C473734:Exubera; D007004:Hypoglycemic Agents; D007328:Insulin