Problems of insulin therapy in type 2 diabetes patient and coexisting diffuse fasciitis with eosinophilia — case report

Abstract

We describe problems of insulin therapy in 61-years old woman with type 2 diabetes treated for last 3 years with pre-mixed insulin given twice a day, in whom essential hyperglycemia occurred in the course of glucosteroid therapy (prednisone 35 mg per day). Corticosteroids were given last month by rheumatologists due to a rare connective tissue disease — diffuse fasciitis with eosinophilia, characterized by symmetrical and significant swelling, induration and thickening of the skin and soft tissues of the limbs, trunk, neck. Insulin was given in basal bolus schema and increased from 0.63 to 1.3 units per kg. Improvement was obtained by using NPH insulin given in the morning at much higher doses than in the evening (22 U v. 7 U) and with the highest doses of insulin aspart for the lunch time (30 U), than for the breakfast and dinner (16 U and 15 U). However, high glucose levels were still observed after lunch, in the afternoon and at dinner time. Injections of higher doses of insulin, especially needed for lunch, were impossible due to extreme induration of the skin, as backward flow of insulin was observed. Satisfactory glucose levels were obtained after introduction of a co-treatment with long acting sulphonylurea in the morning and acarbose for a lunch.