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From Montana, USA:

Our twelve year old daughter has been hospitalized four of the last six weeks with blood sugars between 49 and 1097. Besides an insulin drip, she takes an average of 150-200 units of insulin daily. All injections have been drawn by nurses and observed during the administration. Assuming that what I say, although amazing, is true have you ever seen this and how is it treated?


Insulin resistance is defined as requiring more than 200 units per day in an adult, or more than 2 units per kilogram (approximately one unit per pound) per day in a child. One should always look for causes of insulin resistance such as chronic infection or certain hormonal abnormalities.

Very rarely, insulin resistance can occur when the body produces large amounts of antibodies against insulin. These antibodies bind the insulin and make it ineffective. Sometimes a switch to only Regular insulin, or more recently to lispro insulin (Humalog® brand) may help. Steroids have also been used to lower antibody levels.

You did not mention whether your child was receiving a high dose of intravenous insulin. There is also a syndrome where people are resistant to injected insulin because it is broken down in the skin before it can be absorbed. These people respond well, however, to IV insulin. This has been treated with aprotinin which helps prevent the breakdown of insulin in the skin.

If necessary, your physicians can obtain a more concentrated form of Regular insulin from Eli Lilly (U-500, which contains 500 units per cc rather than the usual 100 units per cc) so larger amounts of insulin can be injected in smaller volumes if necessary.


[Editor's comment: In unusual situations like this, the physicians should include pediatric endocrinologists who specialize in diabetes. Although this may be difficult in rural parts of the USA and in many other parts of the world, the telephone (or referral to a pediatric diabetes program out-of-town) should be used if there are no peds endos nearby. WWQ]

Original posting 25 Jan 97


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Last Updated: Tuesday April 06, 2010 15:08:52
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