INHALED INSULIN IN A PATIENT W/ SUBCUTANEOUS IRS:Case Repot

[mango]

I have never seen this case report before despite it being from last year, but strangely it is on the top of “inhaled insulin” search results in PubMed. Anyways, if this has been posted before sorry.


USE OF INHALED INSULIN IN A PATIENT WITH SUBCUTANEOUS INSULIN RESISTANCE SYNDROME: A RARE CONDITION


ABSTRACT

Objective: Subcutaneous insulin resistance syndrome (SIRS) is a rare entity, characterized by increased resistance to subcutaneous insulin and normal sensitivity to intravenous insulin, with no increase in circulating insulin antibodies. Little is known about its pathophysiology, but it has been suggested to occur due to rapid subcutaneous degradation of insulin. Multiple treatment modalities have been used in the past to treat this condition.

Methods: We illustrate a case of a 17-year-old girl with type 1 diabetes mellitus (T1DM), presenting with recurrent episodes of diabetic ketoacidosis (DKA) due to resistance to subcutaneously delivered insulin.

Results: We describe the challenges faced while attempting different modalities during her hospital stay, and eventually using inhaled insulin, which was recently approved by the Food and Drug Administration for use in nonpregnant adults with T1DM.

Conclusion: SIRS is a difficult condition that may lead to patient frustration and carries a serious risk of recurrent DKA. We described this case to create awareness about SIRS, provide insight into the challenges of its management, and report the use of inhaled insulin to successfully dose meal-time insulin, along with intramuscular glargine for basal insulin.



Full PDF Case Report

[rfogel]

Interesting condition. Googling indicates the pathophysiology is unknown but one researcher suggests it might be due to increased insulin degrading enzyme activity: www.researchgate.net/publication/8997213_Extreme_subcutaneous_insulin_resistance_A_misunderstood_syndrome

I've see reports from patients indicating afrezza seemed to not work as well as when they started. Perhaps the situations are related?

[agedhippie]

I know someone who has that. The usual treatment is an implanted insulin pump that drips insulin directly into the abdominal cavity (this is extremely fast acting). The problem is that the pump is no longer available in the US.

[mango]

Sounds horrendous, aged. In this case, the patient was simply put on Afrezza. Problem solved.

Thank Al for Afrezza!

[agedhippie]

Jan 30, 2020 16:15:04 GMT -5 mango said:

Sounds horrendous, aged. In this case, the patient was simply put on Afrezza. Problem solved.

Thank Al for Afrezza!

While for SIRS using Afrezza is a much better solution than using RAA it still leaves to problem of injecting basal insulin. They cannot inject that normally because it has the same problem as RAA and in the conclusion section of that abstract you see they are using intramuscular injections of Lantus - trust me that really hurts and they are going to have to do it several times a day rather than just once. Afrezza only solves half the problem.

An embedded pump is a far better solution for SIRS if you can get one.