SUCCESSFUL TREATMENT WITH INSULIN ANALOG LISPRO IN IDDM WITH DELAYED ABSORPTION OF SUBCUTANEOUSLY APPLIED HUMAN REGULAR INSULIN AND COMPLICATED INTRAPERITONEAL INSULIN INFUSION - A CASE-REPORT

OBJECTIVE-To subcutaneously administer the insulin analog lispro in a patient with delayed absorption of subcutaneously applied human regula r insulin whose continuous intraperitoneal insulin infusion (CIPII) wi th a percutaneous access device had required multiple surgical interve ntions because of complications.RESEARCH DESIGN AND METHODS-In a 35-ye ar-old woman with long-term IDDM and delayed absorption of subcutaneou sly applied human regular insulin, a 3-year CIPII with human regular i nsulin via a percutaneous access device was complicated by three cathe ter obstructions and one subcutaneous abscess. Each complication requi red the implantation of a new percutaneous access device. During a 2-d ay trial with continuous subcutaneous insulin infusion (CSII) of the i nsulin analog lispro at basal infusion rates of 0.5-1.1 U/h, stable me tabolic control was achieved. A 5-h intermediate attempt with human re gular insulin in CSII, however, increased blood glucose concentrations from 6.0 to 28.8 mmol/l, despite identical basal rates and additional injection of 16 U of human regular insulin. Restarting with CSII of t he insulin analog lispro reinforced stable metabolic control. CONCLUSI ONS-It is suggested that the insulin analog lispro is a promising appr oach in the treatment of IDDM with delayed absorption of subcutaneousl y applied human regular insulin and a suitable alternative therapy for patients with complications attributed to percutaneous access devices for CIPII.