Abstract
We herein describe the case of a 63-year-old man with type 2 diabetes mellitus diagnosed eight years ago who developed a rash and hepatic dysfunction following the subcutaneous injection of insulin (i.e. insulin aspart, insulin lispro and regular human insulin). He was diagnosed with pancreatic cancer and admitted to our hospital for pancreaticoduodenectomy in May 2011. Despite the administration of oral hypoglycemic therapy, the patient's blood glucose control was poor (HbA1c: 8.5 %; non-fasting blood glucose: 355 mg/dl), which necessitated the inclusion of insulin in his perioperative blood glucose management regimen. The patient tested negative for insulin-specific IgE antibodies. Drug lymphocyte stimulation tests and intradermal skin tests for various types of insulin also yielded negative results. Subsequently, he tested positive on a zinc patch test, thus indicating that he had a zinc allergy. However, no allergic reactions were recorded following the administration of zinc-free insulin glulisine via continuous subcutaneous insulin infusion (CSII). This procedure proved efficacious in achieving perioperative glycemic control after pancreaticoduodenectomy. The findings of this case show that CSII treatment with insulin glulisine is very effective for obtaining perioperative glycemic control after pancreaticoduodenectomy in type 2 diabetes patients with zinc allergies.
