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Published on: February 16, 2020
Successful treatment of severe subcutaneous insulin resistance with inhaled insulin therapy
A A E M van Alfen-van der Velden1, C Noordam, B E de Galan
1Metabolic and Endocrine Diseases at Department of Pediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands. j.vanalfen@cukz.umcn.nl
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.
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