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

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