ABSTRACT
A portable insulin-infusion device (Siemens-Erlangen) was used by 24-year-old juvenile onset-type diabetic woman for a period of 5 months in order to achieve normoglycaemic conditions. The patient suffered from rapidly deteriorating florid proliferative retinopathy and was practically blind. Kidney function was serioudly impaired and severe neuropathy also existed. Insulin was infused through a polyethylene catheter inserted through the subclavian vein into a central vein. A continuous basal rate which was varied from day to night was infused with additional supplementary rectangular profiles of insulin at meals. Blood glucose was self-monitored with strip test apparatus in order to adjust insulin dosage to diet. HbA1 decreased from 16% during the pre-therapy phase to 8% (= normal range) at the end of the last phase. MBG decreased from 238 during the pre-therapy phase (6 24 hr profiles at 5 to 7 time points) to 97 during the latter phase (daily profiles from day 103 to day 150). After 3 weeks of this treatment the retinal bleeding had disappeared. During further treatment regression of the massive vascular proliferation was observed with fluorescein angiography, and perfusion of the retina improved. Vision also improved, so that the patient has now been able to resume her work as a bank employee. Albuminuria decreased and the neuropathic symptoms also disappeared. The originally planned hypophysectomy was, therefore, considered to be unnecessary.
