Continuous subcutaneous insulin infusion allows tolerance induction and diabetes treatment in a type 1 diabetic child with insulin allergy
| Autor: | C. Raverdy, N. Tubiana-Rufi, A. Sola-Gazagnes, J.-B. Lobut, Jean-Claude Carel, C. Pecquet, C. Hasselmann, E. Bismuth |
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| Rok vydání: | 2013 |
| Předmět: |
Blood Glucose
Male medicine.medical_specialty Allergy Basal rate Urticaria Endocrinology Diabetes and Metabolism medicine.medical_treatment Infusions Subcutaneous Drug Hypersensitivity Insulin Infusion Systems Endocrinology Bolus (medicine) Diabetes mellitus Internal Medicine medicine Humans Hypoglycemic Agents Insulin Child Lipoatrophy Diabetes Mellitus Lipoatrophic Type 1 diabetes business.industry General Medicine medicine.disease Surgery Tolerance induction Diabetes Mellitus Type 1 Treatment Outcome Thigh Anesthesia business |
| Zdroj: | Diabetes & Metabolism. 39:174-177 |
| ISSN: | 1262-3636 |
| DOI: | 10.1016/j.diabet.2012.10.002 |
| Popis: | Aim Insulin allergy is a rare but serious and challenging condition in patients with type 1 diabetes (T1D). This is a case report of an 8-year-old boy with T1D and an allergy to insulin. Case report Three months after being diagnosed with T1D, the patient developed progressive skin reactions to insulin, characterized by small 1.5-cm pruritic wheals at injection sites that persisted for several days. Seven months after diagnosis, he experienced two episodes of generalized urticaria with systemic symptoms that were seen within a few seconds of insulin injection. Examination revealed lipoatrophy of the thighs. Intradermal skin tests were positive for protamine, glargine and lispro. The patient was started on a continuous subcutaneous insulin infusion (CSII) tolerance induction protocol, consisting of a very low basal rate that was progressively increased, with the first bolus given under medical supervision, and was well tolerated for 4 months. After this period of time, the skin wheals reappeared, localized to the infusion sites, but without urticaria or any other generalized reactions. Intradermal skin tests were repeated and were again positive. Serum insulin-specific IgE measured 30 months after the first allergic reactions were positive. After 3 years, pump therapy is ongoing and blood glucose control has remained relatively good (HbA 1c 7.6%). Conclusion In T1D children with insulin allergy, CSII can successfully be used to both induce insulin tolerance and allow diabetes insulin therapy, although insulin desensitization cannot always be fully achieved. The induction protocol was easily manageable partly due to the "honeymoon" period that the patient was still in, but it should nonetheless be used even when the patient has higher insulin requirements. |
| Databáze: | OpenAIRE |
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