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[IPm] (Fwd) [peds-endo] Diabetes unresponsive to SQ insulin!

Forwarded from the peds-endo list. This patient needs your 
assistance. Please respond directly to Dr Eapen, not an ip-medpro 
list member.

email @ redacted

------- Forwarded Message Follows -------
To:            "'email @ redacted'" <email @ redacted>
From:          "Eapen, Santhosh" <email @ redacted>
Date:          Sat, 2 Feb 2002 09:38:32 -0500
Subject:       [peds-endo] Diabetes unresponsive to SQ insulin!
Reply-to:      email @ redacted

Desperately need your help, all comments/suggestions gratefully

I have a 16 year old girl with diabetes (poorly controlled) in the
PICU on a heparin drip for a pulmonary embolus (not really sure why
she developed it, but she was on OCP's and her blood sugars have been
very high - ? dehydration). Her blood sugars have been very difficult
/ impossible to control on several different combinations of SQ
insulin - the insulin pump, NPH/Humalog, NPH/regular,
Lantus/Novolog/Humalog, despite pushing her daily insulin dose to over
2 u/kg/day. Her readings constantly reads HI on the monitor, but
enough insulin appears to be absorbed to prevent her from going into
full blown DKA. The SQ insulin was given in the hospital, so there is
no question about compliance.

She is however, unbelieveably well controlled on an i.v. insulin drip
(that the intensivist is managing with a sliding scale based on her
blood sugars), and she maintains her blood sugars between 70 - low
130's, with occasional spikes after meals that quickly come down as
the insulin rate is increased.

Any thoughts? Would appreciate any input.

Santhosh Eapen
Pediatric Endocrinologist
Jersey Shore Medical Center

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