REDUCTION IN SUBCUTANEOUS INSULIN REQUIREMENTS IN TETRAPLEGIC TYPE 1 DIABETIC WITH CERVICAL SPINAL CORD INJURY FOLLOWING PRAMLINTIDE TREATMENT

AACE Clinical Case Reports
Frank Salamone, Brian A Berelowitz

Abstract

To report a massive increase in subcutaneous insulin requirements following spinal cord injury in a type 1 diabetic and how it was managed over a 22-month period with pramlintide. A case report and brief literature review is presented. The patient is a 43-year-old male who was diagnosed with type 1 diabetes mellitus at age 18. He remained relatively well-controlled without end-organ complications until age 37, when he developed a spinal epidural abscess following a methicillin-resistant Staphylococcus aureus cellulitis of the foot. The patient became ventilator-dependent and tetraplegic. He remained in rehabilitation for 18 months and returned home with a total daily dose of subcutaneous insulin of 600 U (4 U/kg); a 500 U increase over his prespinal cord injury requirements. Total daily intravenous insulin requirement was determined to be 259 U (1.96 U/kg). The patient was started on pramlintide. Twenty-two months after the onset of pramlintide treatment his total daily dose of subcutaneous insulin was decreased to 150 U (1.3 U/kg). Maintenance of glycemic control and obesity in type 1 diabetics with spinal cord injury may be complicated by autonomic dysregulation and the inability to induce activity-related lifestyle changes. ...Continue Reading

References

Jul 17, 2009·The Journal of Biological Chemistry·Edward J HalveyJohn Garthwaite
Aug 18, 2009·Respiratory Physiology & Neurobiology·Andrei Krassioukov
Feb 1, 2014·Physiology & Behavior·Elizabeth G Mietlicki-Baase, Matthew R Hayes
Jul 9, 2014·The Journal of Spinal Cord Medicine·Ashraf S GorgeyDavid R Gater
Jun 14, 2015·Pharmacological Reviews·Debbie L HayJonathan D Roth

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