REDUCTION IN SUBCUTANEOUS INSULIN REQUIREMENTS IN TETRAPLEGIC TYPE 1 DIABETIC WITH CERVICAL SPINAL CORD INJURY FOLLOWING PRAMLINTIDE TREATMENT

AACE Clinical Case Reports, 2020 · DOI: 10.4158/ACCR-2019-0461 · Published: May 1, 2020

Simple Explanation

A 43-year-old male with type 1 diabetes experienced a significant increase in insulin requirements after developing tetraplegia due to a spinal cord injury. Treatment with pramlintide, an amylin analog, helped reduce the patient's insulin needs and led to weight loss. The case suggests that autonomic dysregulation following spinal cord injury may impair subcutaneous insulin absorption, and pramlintide can be a useful adjunct therapy.

Study Duration

22 months

Participants

A 43-year-old male with type 1 diabetes and tetraplegia

Evidence Level

Case Report

Key Findings

1
The patient's subcutaneous insulin requirements increased dramatically to 600 U/day after spinal cord injury, compared to 81 U/day before the injury.
2
Pramlintide treatment over 22 months reduced the patient's subcutaneous insulin dose to 150 U/day and resulted in a 19 kg weight loss.
3
The intravenous insulin requirement was significantly lower than the subcutaneous requirement, suggesting impaired subcutaneous absorption.

Research Summary

This case report describes a type 1 diabetic patient who developed tetraplegia and experienced a massive increase in subcutaneous insulin requirements. Treatment with pramlintide led to a significant reduction in insulin dosage and weight loss, improving the patient's quality of life. The authors suggest that autonomic dysregulation following spinal cord injury may impair subcutaneous insulin absorption, making pramlintide a useful adjunctive therapy.

Practical Implications

Clinical Management

Consider pramlintide as an adjunctive therapy for type 1 diabetics with spinal cord injury experiencing high insulin requirements.

Research

Further research is needed to understand the mechanisms by which spinal cord injury affects subcutaneous insulin absorption and the role of pramlintide in these patients.

Patient Education

Educate patients with spinal cord injuries and diabetes about the potential for altered insulin absorption and the importance of close monitoring.

Study Limitations

1
Single case report limits generalizability.
2
Lack of radiolabeled insulin studies to confirm the mechanism of pramlintide's effect.
3
Limited resources at the private practice prevented more detailed investigations.

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