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Beta-cell transplantation restores metabolic control and quality of life in a patient with subcutaneous insulin resistance.

Islet cell transplantation can achieve good metabolic control in type 1 diabetic patients (1–4) and may therefore delay or prevent the development of chronic complications when graft function can be maintained long term. A β-cell implant can also generate preliminary benefits in avoiding hypoglycemic episodes, which is particularly useful in patients with frequent episodes of hypoglycemia and with hypoglycemic unawareness. We now report another immediate benefit in restoring insulin action in patients with subcutaneous insulin resistance.

The patient developed type 1 diabetes at age 24 years. Subcutaneous insulin therapy initially achieved acceptable glycemic control (average insulin dose 30 IU/day, HbA1c 7% [normal range 4–6%]; HPLC; Pharmacia Biotech, Uppsala, Sweden). However, 1 year after diagnosis, a state of insulin resistance progressively developed with difficulty controlling hyperglycemia despite the use of excessively high doses of insulin (>400 IU/day). During hospitalization, this resistance was correlated with subcutaneous insulin administration; it disappeared within 2–3 h after starting intravenous insulin therapy and reappeared within 1 day after returning to the subcutaneous route. Measurements of insulin levels confirmed low insulin resorption from subcutaneous injection sites, whereas adding aprotinin to the insulin preparation did not improve insulin absorption. There was no evidence for a condition of pseudoresistance …