Kampmann Ulla, Ovesen Per Glud, Møller Niels, Fuglsang Jens
Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager, Aarhus N, Denmark.
Department of Obstetrics and Gynecology, Department of Diabetes and Endocrinology, Aarhus University Hospital, Palle Juul Jensens Boulevard, Aarhus N, Denmark.
Endocrinol Diabetes Metab Case Rep. 2021 Jul 1;2021. doi: 10.1530/EDM-20-0191.
During pregnancy, maternal tissues become increasingly insensitive to insulin in order to liberate nutritional supply to the growing fetus, but occasionally insulin resistance in pregnancy becomes severe and the treatment challenging. We report a rare and clinically difficult case of extreme insulin resistance with daily insulin requirements of 1420 IU/day during pregnancy in an obese 36-year-old woman with type 2 diabetes (T2D) and polycystic ovary syndrome (PCOS). The woman was referred to the outpatient clinic at gestational week 12 + 2 with a hemoglobin A1c (HbA1c) at 59 mmol/mol. Insulin treatment was initiated immediately using Novomix 30, and the doses were progressively increased, peaking at 1420 units/day at week 34 + 4. At week 35 + 0, there was an abrupt fall in insulin requirements, but with no signs of placental insufficiency. At week 36 + 1 a, healthy baby with no hypoglycemia was delivered by cesarean section. Blood samples were taken late in pregnancy to search for causes of extreme insulin resistance and showed high levels of C-peptide, proinsulin, insulin-like growth factor (IGF-1), mannan-binding-lectin (MBL) and leptin. CRP was mildly elevated, but otherwise, levels of inflammatory markers were normal. Insulin antibodies were undetectable, and no mutations in the insulin receptor (INSR) gene were found. The explanation for the severe insulin resistance, in this case, can be ascribed to PCOS, obesity, profound weight gain, hyperleptinemia and inactivity. This is the first case of extreme insulin resistance during pregnancy, with insulin requirements close to 1500 IU/day with a successful outcome, illustrating the importance of a close interdisciplinary collaboration between patient, obstetricians and endocrinologists.
This is the first case of extreme insulin resistance during pregnancy, with insulin requirements of up to 1420 IU/day with a successful outcome without significant fetal macrosomia and hypoglycemia. Obesity, PCOS, T2D and high levels of leptin and IGF-1 are predictors of severe insulin resistance in pregnancy. A close collaboration between patient, obstetricians and endocrinologists is crucial for tailoring the best possible treatment for pregnant women with diabetes, beneficial for both the mother and her child.
在孕期，母体组织对胰岛素的敏感性逐渐降低，以便为生长中的胎儿释放营养供应，但孕期胰岛素抵抗偶尔会变得严重，治疗颇具挑战性。我们报告了一例罕见且临床棘手的极度胰岛素抵抗病例，一名患有2型糖尿病（T2D）和多囊卵巢综合征（PCOS）的36岁肥胖女性，孕期每日胰岛素需求量达1420国际单位/天。该女性在妊娠12 + 2周时因糖化血红蛋白（HbA1c）为59 mmol/mol被转诊至门诊。立即开始使用诺和锐30进行胰岛素治疗，剂量逐渐增加，在34 + 4周时达到峰值1420单位/天。在35 + 0周时，胰岛素需求量突然下降，但无胎盘功能不全迹象。在36 + 1周时，通过剖宫产分娩出一名健康婴儿，无低血糖情况。在妊娠晚期采集血样以寻找极度胰岛素抵抗的原因，结果显示C肽、胰岛素原、胰岛素样生长因子（IGF - 1）、甘露糖结合凝集素（MBL）和瘦素水平升高。C反应蛋白（CRP）轻度升高，但其他炎症标志物水平正常。未检测到胰岛素抗体，且未发现胰岛素受体（INSR）基因突变。在该病例中，严重胰岛素抵抗的原因可归因于PCOS、肥胖、体重显著增加、高瘦素血症和缺乏运动。这是孕期极度胰岛素抵抗的首例病例，胰岛素需求量接近1500国际单位/天且结局成功，说明了患者、产科医生和内分泌科医生之间密切跨学科合作的重要性。
这是孕期极度胰岛素抵抗的首例病例，胰岛素需求量高达1420国际单位/天且结局成功，无明显巨大儿和低血糖情况。肥胖、PCOS、T2D以及高水平的瘦素和IGF - 1是孕期严重胰岛素抵抗的预测因素。患者、产科医生和内分泌科医生之间的密切合作对于为糖尿病孕妇量身定制最佳治疗方案至关重要，对母亲和孩子均有益。
