We Report a case of severe brittle diabetes with undetectable C-peptide, in whom near-normal glucoregulation was successfully achieved by coritinuous intraperitoneal insulin infusion (CIPII) with a portable pump, although our first attempt to achieve a fair metabolic equilibrium by either intensified conventional insulin therapy (ICIT) with self-monitoring blood glucose or continuous insulin infusion (CSII) resulted in failure.
The patient, a 57-year-old man with a 26-year history of diabetes was admitted to our hospital on September 16, 1983 for poor control of blood glucose. He had been receiving injections of a mixture of short-acting and intermediate insulin three times a day.
Six-day glycemic profiles obtained with each treatmet, by ICIT, CSII and CIPII were compared. The M value of each treatment was 117.8±36.2 (mean±SD), 43.7±20.4 and 5.4±1.2 respectively.
The blood glucose level during CIPII was between 75-180 mg/dl, and the plasma-free IRI concentration wat periodically measured 23 times between 6: 30 and 21: 00. A sharp peak of free IRI, coincident with the rise in glucose after each meal, was obtained. This was similar in the plasma insulin profile pattern to normal subjects.
This report suggests that CIPII can maintain near-normal glucoregultion even in C-peptide negative brittle diabetics, who are unable to achieve good glycemic control by conventional ICIT or CSII methods.