Extreme Subcutaneous, Intramuscular and Inhaled Insulin Resistance Treated by Pancreas Transplantation Alone

Extreme Subcutaneous, Intramuscular and Inhaled Insulin Resistance Treated by Pancreas Transplantation Alone

Author Sá, J. R. Autor UNIFESP Google Scholar
Alvarenga, Marcelo A. Autor UNIFESP Google Scholar
Rangel, Erika B. Autor UNIFESP Google Scholar
Melaragno, Claudio S. Autor UNIFESP Google Scholar
Gonzalez, Adriano M. Autor UNIFESP Google Scholar
Linhares, Marcelo Moura Autor UNIFESP Google Scholar
Salzedas, A. Autor UNIFESP Google Scholar
Carmona, Adriana K. Autor UNIFESP Google Scholar
Tonetto-Fernandes, Vania Autor UNIFESP Google Scholar
Gabbay, Monica Andrade Lima Autor UNIFESP Google Scholar
Pestana, Jose Osmar Medina Autor UNIFESP Google Scholar
Dib, Sergio Atala Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Hosp Infantil Darcy Vargas
Abstract Diabetes mellitus with resistance to insulin administered subcutaneously or intramuscularly (DRIASM) is a rare syndrome and is usually treated with continuous intravenous insulin infusion. We present here two cases of DRIASM in 16 and 18 years female patients that were submitted to pancreas transplantation alone (PTA). Both were diagnosed with type 1 diabetes as young children and had labile glycemic control with recurrent episodes of diabetic ketoacidosis. They had prolonged periods of hospitalization and complications related to their central venous access. Exocrine and endocrine drainages were in the bladder and systemic, respectively. Both presented immediate graft function. in patient 1, enteric conversion was necessary due to reflux pancreatitis. Patient 2 developed mild postoperative hyperglycemia in spite of having normal pancreas allograft biopsy and that was attributed to her immunosuppressive regimen. Patient 1 died 9 months after PTA from septic shock related to pneumonia. in 8 months of follow-up, Patient 2 presented optimal glycemic control without the use of antidiabetic agents. in conclusion, PTA may be an alternative treatment for DRIASM patients.
Keywords Diabetes mellitus
insulin resistance
pancreas transplantation alone
Language English
Sponsor Brazilian Public Health System
Date 2010-01-01
Published in American Journal of Transplantation. Malden: Wiley-Blackwell Publishing, Inc, v. 10, n. 1, p. 184-188, 2010.
ISSN 1600-6135 (Sherpa/Romeo, impact factor)
Publisher Wiley-Blackwell
Extent 184-188
Origin http://dx.doi.org/10.1111/j.1600-6143.2009.02726.x
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000272882000028
URI http://repositorio.unifesp.br/handle/11600/32030

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