Evidence-Based Treatment of Subcutaneous Insulin Resistance in a Type 1 Diabetic Female

Objective To develop an evidence-based treatment plan for a type 1 diabetic female who was resistant to subcutaneous insulin injection but sensitive to intravenous insulin infusion. Methods Articles in ACP Journal Club,Cochrane library,PubMed and CNKI were searched according to the clinical question. The quality and applicability of systematic review and original literature were evaluated respectively. Results There was one article about the diagnosis of subcutaneous insulin resistance. Other five articles were related to the treatment,including intravenous insulin infusion, intraperitoneal insulin infusion, intramuscular insulin injection and continuous subcutaneous insulin infusion via an insulin pump, et al. Those articles indicated that ketosis reoccurred when only subcutaneous insulin was administered, but those special treatment mentioned above could manage hyperglycemia. There was no report whether the insulin analog could manage subcutaneous insulin resistance until now. So the treatment of subcutaneous insulin analog and oral glycosidase inhibitor was applied in the patient on the basis of assessing the objective evidence, the aspiration of the patient,the condition of economy and technology. The treatment turned out to be successful after 15 months follow-up visit. Conclusion The evidence-based medicine contributes to the early diagnosis and reasonable treatment of subcutaneous insulin resistance.