Treating New-Onset Catabolic Type 2 Diabetes With Glargine and Lispro

Abstract

N.D., a 38-year-old African-American woman, was admitted to the hospital with a plasma glucose level of 793 mg/dl and 2+ urine ketones. She had no history of diabetes and last saw her primary care provider 6 months ago for her annual examination. Her plasma glucose level was normal at that time. She had lost 30 lb in the past 8 weeks, and she reported having had polyuria and polydipsia for 2 weeks. She reported anorexia with very little oral intake for the past 2 days. Her weight was 220 lb (100 kg). Physical examination showed acanthosis nigricans and morbid obesity. She had been given 10 units of regular insulin subcutaneously and 2 l of normal saline intravenously in the emergency department, resulting in a plasma blood glucose of 525 mg/dl. Results of a basic chemistry panel were: 1. Sodium: 134 mg/dl 2. Potassium: 3.9 mg/dl 3. Bicarbonate: 20 mg/dl 4. Chloride: 100 mg/dl 5. Creatinine: 1.0 mg/dl Overnight, she was given “sliding scale” insulin, 10 units every 6 hours, for glucose levels consistently > 400 mg/dl. The next morning, an insulin drip was started. During the next 24 hours, 100 units of intravenous lispro in a drip resulted in a fasting plasma glucose of 120 mg/dl. Her hemoglobin A1c (A1C) was 12.2%. The next evening, she was given 50 units of glargine with premeal supplements of lispro to a total of 50 units (15 units at breakfast, 15 units at lunch, and 20 units at dinner). Her blood glucose levels now were well controlled without initial hypoglycemia. During the next …