A Pediatric Case of Insulin Lispro U-200 as Continuous Insulin Infusion to Treat Type 1 Diabetes Mellitus Complicated by Insulin Resistance

• Main Authors: Grace Kim, MD, Vanessa Waldrep, ARNP
• Format: Article
• Language: English
• Published: Elsevier 2018-09-01
• Series: AACE Clinical Case Reports
• Online Access: http://www.sciencedirect.com/science/article/pii/S2376060520301668

ABSTRACT: Objective: To report the clinical course of a pubertal pediatric patient with type 1 diabetes mellitus complicated by insulin resistance treated with concentrated insulin lispro (U-200) as a continuous subcutaneous insulin infusion.Methods: We present a case report with a review of the relevant literature.Results: After initiation of insulin lispro U-200, the patient was able to reduce the volume of insulin injection per day. Hemoglobin A1c decreased from 7.2 to 6.9% (55 to 52 mmol/mol). Based on continuous glucose monitoring data, the patient's time in the target range increased from 19 to 43%. The frequency of hypoglycemia was 9%, with no severe hypoglycemia. The patient reported better satisfaction with insulin administration.Conclusion: Insulin lispro U-200 delivered by an insulin pump can result in benefits including fewer insulin pump changes and improved quality of life in pediatric patients with insulin-resistant type 1 diabetes mellitus. Safety measures are needed when using non-standard insulin concentrations, especially concentrated insulins delivered by an insulin pump which was designed for use with insulin lispro U-100.Abbreviations: CSII = continuous subcutaneous insulin infusion;CV = coefficient of variation;T1DM = type 1 diabetes mellitus;T2DM = type 2 diabetes mellitus;TDID = total daily insulin dose;U-100 = insulin lispro U-100;U-200 = insulin lispro U-200