Diabetes resistant to conventional subcutaneous insulin injection is a rare complication of insulin-dependent diabetes which poses a major management problem. We report three cases treated for a total of over seven patient years with fully implanted insulin infusion devices. Technical difficulties with the devices and their operation have been substantial but the patients are much improved and hospitalisation has been dramatically reduced. We suggest that implanted insulin pumps are a real treatment option for patients with this unusual syndrome.
PaulsenEPCourtneyJWDuckworthWC. Insulin resistance caused by massive degradation of subcutaneous insulin. Diabetes1979; 28; 640–645.
3.
McElduffAEastmanCJHaynesSPBowenKM. Apparent insulin resistance due to abnormal enzymatic insulin degradation: A new mechanism for insulin resistance. Aust NZ J Med1980; 10: 56–61.
4.
MaberlyGFWaitGAKilpatrickJA. Evidence for insulin degradation by muscle and fat tissue in an insulin resistant diabetic patient. Diabetologia1982; 23: 333–336.
5.
WilliamsGPickupJClarkABowcockSCookeEKeenH.Changes in blood flow close to subcutaneous insulin injection site in stable and brittle diabetics. Diabetes1983; 32: 466–473.
SchadeDSDuckworthWC. In search of the subcutaneous-insulin-resistance syndrome: N Engl J Med1986; 315: 147–153.
8.
SchadeDSEatonRPDrummDADuckworthWC. A clinical algorithm to determine the etiology of brittle diabetes. Diabetes Care1985; 8: 5–11.
9.
BlackshearPJRohdeTDGrottingJC. Control of blood glucose in experimental diabetes by means of a totally implantable insulin infusion device. Diabetes1979; 28: 634–639.
10.
CampbellIWKritzHNajemnikCHagmüllerGIrsiglerK.Treatment of Type 1 diabetic with subcutaneous insulin resistance by a totally implantable insulin infusion device (‘Infusaid’). Diabetes Res1984; 1: 83–88.
11.
CampbellIWIrsiglerK.Subcutaneous insulin resistance: Treatment by implantable device. In ‘Brittle Diabetes’, ed PickupJC; Blackwell Scientific Publications, Oxford; 1985; Chapter 22, 289–300.
12.
PickupJCBilousRWKeenH.Aprotinin and insulin resistance. Lancet1980; 2: 93–94 (letter).
13.
DandonaPMierABoagFChappellMBeckettAG. Aprotinin induced lipohypertrophy and glomerulonephritis in an insulin dependent diabetic. Diabetes Res1985: 2; 213–216.
14.
SchadeDSEatonRPWarholRM. Subcutaneous peritoneal access device for Type 1 diabetic patients non-responsive to subcutaneous insulin. Diabetes1982; 31: 470–473.
15.
DandonaPFonsecaVFernandoO. Control of diabetes trough a subcutaneous peritoneal access device (SPAD) in patients with resistance to subcutaneously injected insulin. Diabetes Res1987 (in press).
16.
BaylissJ.Brittle diabetes: Long-term control with a portable, continuous, intravenous insulin system. Brit Med J1981; 283: 1207–1209.
17.
PickupJCHomePDBilousRWKeenH, Alberti KGMM. Management of severely brittle diabetes by continuous subcutaneous and intramuscular insulin infusions: Evidence for a defect in subcutaneous insulin absorption. Brit Med J1981; 282: 347–350.
18.
HusbandDJMarshallSMWalfordSHanningIWrightPD, Alberti KGMM. Continuous intraperitoneal insulin infusion in the management of severely brittle diabetes — A metabolic and clinical comparison with intravenous insulin. Diabetic Medicine1984: 1: 99–104.
19.
MicossiPBosiECristalloM. Chronic continuous intraperitoneal insulin infusion (CIPII) in Type 1 diabetic patients non-satisfactorily responsive to continuous subcutaneous insulin infusion (CSII). Acta Diabetol Lat1986; 23: 166–164.
20.
GillGVHusbandDJWrightPD. The management of severe brittle diabetes with ‘Infusaid’ implantable pumps. Diabetes Res1986; 3: 135–137.
21.
BuchwaldHChuteEPGoldenbergF. Implantable infusion pump management of insulin resistant diabetes mellitus. Ann Surg1985; 202: 278–282.
22.
HenryDALoweJMCitrinDMandersonWG. Defective absorption of subcutaneous insulin. Lancet1978; 2: 741.