Extreme subcutaneous, intramuscular and inhaled insulin resistance treated by pancreas transplantation alone.
Diabetes mellitus with resistance to insulin administered subcutaneously or intramuscularly (DRIASM) is a rare syndrome and is usually treated with continuous intravenous insulin infusion. We present here two cases of DRIASM in 16 and 18 years female patients that were submitted to pancreas transplantation alone (PTA). Both were diagnosed with type 1 diabetes as young children and had labile glycemic control with recurrent episodes of diabetic ketoacidosis. They had prolonged periods of hospitalization and complications related to their central venous access. Exocrine and endocrine drainages were in the bladder and systemic, respectively. Both presented immediate graft function. In patient 1, enteric conversion was necessary due to reflux pancreatitis. Patient 2 developed mild postoperative hyperglycemia in spite of having normal pancreas allograft biopsy and that was attributed to her immunosuppressive regimen. Patient 1 died 9 months after PTA from septic shock related to pneumonia. In 8 months of follow-up, Patient 2 presented optimal glycemic control without the use of antidiabetic agents. In conclusion, PTA may be an alternative treatment for DRIASM patients.
Sa
J R
JR
Endocrinology Division, Department of Medicine, Federal University of Sao Paulo, and Hospital Infantil Darcy Vargas, São Paulo, Brazil. jrsa@uol.com.br
Alvarenga
M A
MA
Rangel
E B
EB
Melaragno
C S
CS
Gonzalez
A M
AM
Linhares
M M
MM
Salzedas
A
A
Carmona
A K
AK
Tonetto-Fernandes
V
V
Gabbay
M A
MA
Medina Pestana
J O
JO
Dib
S A
SA
D000280:Administration, Inhalation; D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000601:surgery*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D007333:Insulin Resistance; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000502:physiology; D012772:Shock, Septic / Q000209:etiology
D001786:Blood Glucose; D007328:Insulin