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Question:

From Saskatoon, Saskatchewan, Canada:

I am a 44 year old female who has been diagnosed for 2 years (my medical team suspects it may have been longer as my last baby 13 years ago was 13 pounds, 14 ounces at birth and I had gestational diabetes at that time). I have been diagnosed as being insulin resistant. I am currently taking in excess of 1000 units per day which keeps my readings in the range of 20 - 30 mmol/l. In the past 3 months we have received government approval for exceptional emergency status to use Lilly U-500 concentrated insulin, which is not available in Canada. We cannot get approval for Rezulin which I have been told could be effective as there is a freeze on this drug in Canada. In the past month my sodium levels have dropped very low and the triglyceride levels have risen to over 19. I have been told there is a relationship between these two readings. Could you clarify this relationship? Also, the only way we seem to get the levels down to approximately 15 mmol/l is hospital admission with insulin drips. We have been closely monitoring diet and exercise which I am following, however I do have a fairly high stress level as a single parent of 4 teenage boys!

From your experience do you have any suggestions on anything that may have helped any of your patients that I could try? I have an excellent endocrinologist and family physician, but am hoping that someone may have an idea that could help as I desperately want to avoid hospitalizations. I am currently taking 60 units of concentrated R at morning, lunch and supper and 120 units of regular concentration R and 45 Ultralente at night.

Answer:

The information that you have provided is not enough to be able to say exactly what type of insulin resistance you have. It might help to talk to your doctors about this and at the same time there are some other issues that would be worth going over. First of all, it seems that one of your main problems has been to get enough insulin and in this connection you might talk to your team about using the U-500 insulin in a pump: in one case this worked well in someone who was on much higher doses than yourself although it did involve more frequent catheter insertions. This step might afford the flexibility to avoid constant hospitalisation. There has also been a report on the successful reduction of insulin needs with the use of 'Insulin like growth factor 1'; but I suspect that this is not a very practical suggestion. There have been no published reports so far on the use of Rezulin in cases like yours; but it would certainly be worth a trial. Your doctor would have to obtain this through friends in the U.S. where it is still an approved drug. Another possibility would be to have him/her write to the manufacturers to see if they could get a small supply: at this stage they would surely welcome an opportunity to show that there was a clinical situation where the benefits far outweighed the risks.

The low sodium is probably an artefact. When a blood sample is drawn and taken to the lab to measure sodium, the red cells are centrifuged off. In your case the residual serum contains an unusually high proportion of lipid which will give it a milky appearance. Usually in measuring sodium no steps are taken to remove this lipid before introducing the sample into the flame photometer. The result is expressed per volume of serum + lipid whereas it should be corrected as per volume of serum because the lipid though it increase the volume does not contain any of the sodium. Not too clear I'm afraid, but next time you are in hospital ask one of the lab technicians who I suspect will explain all this much better. But whilst on the subject of high lipids, I think you should talk to your doctors about treatment of this aspect, because if nothing is done it may lead to episodes of pancreatitis. The most commonly used drugs are fibrates like Gemfibrosil; but some of the newer variants may be available in Canada.

DO'B

Original posting 8 May 1998
Posted to Insulin and Medications: Pills for Diabetes

  
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Last Updated: Tuesday April 06, 2010 15:08:58
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