From Jackson, Tennessee, USA:
My 13 year old niece has been Type 1 since age 2 with many control problems. Approximately 6 months ago, she was diagnosed with gastroparesis, and now antibodies to pork and beef, no longer able to do SQ [subcutaneous] shots, must do IM [intramuscular] (usually at least 6 daily). Lots of health problems, hospitalized every two weeks with severe ketoacidosis. Health failing fast. Will an insulin pump be of any advantage to her? Her diabetes program, at a major teaching hospital dragging their feet on aggressive therapy: how can we (family) help her?
It sounds like your niece's problems are much too complex to diagnose and treat on-line. A few thoughts:
- If your niece can't take subcutaneous insulin, she will not be able to use the insulin pump in the usual fashion which gives the insulin subcutaneously. If she has the extremely rare problem that the insulin is being broken down in the skin before it is absorbed, she might respond to the addition of aprotinin to the insulin to prevent breakdown of the insulin in the skin. Insulin has also occasionally been given intravenously using a pump.
- If your niece has antibodies to beef and pork insulin, I am not sure why she hasn't been tried on human insulin. If she also has antibodies to human insulin, there have been reports of individuals being treated with lispro insulin [Humalog®] successfully (using an insulin pump - but assuming she isn't breaking down the insulin in the skin.) Steroid treatment has also been used to treat this problem (called insulin resistance.)
- It would be extremely unusual to see gastroparesis at such a young age. Sometimes other gastrointestinal problems such as lactose intolerance, celiac disease, inflammatory bowel disease, or gastro-esophageal reflux are misdiagnosed as gastroparesis in people with diabetes. I assume she has had a full gastrointestinal evaluation.
Of course, there is also the possibility that her control is so difficult because of emotional problems.
I hope the family and her medical team can sort out these problems.
Original posting 16 Mar 1998
Posted to Daily Care
Last Updated: Tuesday April 06, 2010 15:08:54
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