Insulin
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Insulin Development of drug resistance: case report
A 77-year-old man developed drug resistance during treatment with insulin for intractable hyperglycaemia. The man was admitted to the ICU for hypotension, drowsiness and confusion one day after axillary lymph node excisional biopsy for haematologic malignancy. He had various concurrent conditions such as chronic obstructive pulmonary disease, hypertension, autoimmune haemolytic anaemia and thrombocytopenia due to Evans syndrome. He underwent transfusion with RBCs and platelet concentrate. He received concurrent methylprednisolone [Metilprednisolone] and immune globulin. Further, he was found to have hyperglycaemia (234 mg/dL) for which he received IV boluses of insulin [Actrapid supplied by Novo Nordisk; recombinant human fast-acting insulin]. Consequently, his blood glucose normalised. However, after 2 days, he developed insulin-resistance with hyperglycaemia (456 mg/dL) with normal plasma sodium level and no ketoacidosis. Despite multiple incremental IV boluses insulin up to 50 UI with continuous IV infusion of insulin 8 UI/h, his glycaemia was still >400 mg/dL. On the basis of all these, he was diagnosed with acquired resistance to insulin. The man’s therapy was changed to insulin aspart following which his glycaemia significantly improved. Following further doses of insulin aspart, his blood glucose reached to
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