EXTREME INSULIN-RESISTANCE - CLINICAL MANAGEMENT BY EXTERNAL SUBCUTANEOUS INSULIN INFUSION

Management of very high insulin requirements in rare extreme insulin r esistance syndromes is difficult and poorly documented. We report a ca se of a type B insulin-resistant patient requiring approximately 10,00 0 units of insulin per day, i.e. beyond the possibilities of current i nsulin formulations and delivery devices. Only the Panomat C10 portabl e pump model (Disetronic) and U500 Humulin (Lilly) allowed the require d rate of 400 units per hour to be attained only when the reservoir wa s changed twice daily and the site and catheter were changed once dail y. Three months after discharge, the patient was in good general and l ocal condition, but with only fair diabetes control (glycated haemoglo bin 9.5 %).