A type 2 diabetic patient with liver dysfunction due to human insulin

A 45-year-old man had been complaining of thirst and polydypsia For the las t 3 months and was diagnosed as having type 2 diabetes mellitus because his fasting blood glucose showed 221 mg/dl with positive urinary ketone. He wa s hospitalized to a private hospital and Penfil 30R(R) was started. However , serum gamma-GTP and aminotransferases began to elevate after insulin trea tment and exceeded 1000 IU/I. Insulin was discontinued and serum gamma-GTP and aminotransferases returned close to the normal range. Since his glycemi c control became poor again, Penfil 30R" was restarted and serum gamma-GTP and aminotransferases elevated again. Therefore, insulin was discontinued a nd the patient was referred to the Third Department of Internal Medicine, Y amanashi Medical University Hospital because of liver dysfunction. His plas ma glucose decreased by diet therapy, and improved further by the administr ation of glibenclamide. After obtaining informed consent, Humalin R(R) was challenged. Seven days after insulin injection, serum aminotransferases beg an to elevate again. Lymphocyte stimulation test was negative against three preparations (Penfil R(R), Penfil N(R) and Humalin R(R)). The present case suggests that human insulin itself can cause liver dysfunction and we need to pay more attention to liver function tests when we start insulin treatm ent. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.