Abstract
Urinary tract infection in diabetic patients with neurogenic bladders is often difficult to treat. We report one case of poorly controlled diabetes complicated with severe hemorrhagic cystitis, which was improved after controlling blood glucose by continuous subcutaneous insulin infusion (CSII). The patient was a 63-year-old woman. She was diagnosed as diabetic at the age of 53 and, since that time, she had been treated with insulin. But the diabetic control had been poor.
In 1976, when she was 59 years old she underwent photocoagulation for diabetic retinopathy and surgery for cataracts. Around that time, she started to complain of pain in her feet and legs. In November 1980, she was admitted to our hospital for the treatment of diabetes and hemorrhagic cystitis, Insulin was injected subcutaneously two or three times a day, and total daily insulin dose was increased up to 100 units. The control of blood glucose was unsatisfactory. For the hemorrhagic cystitis, antibiotics were administered, and electrocoagulation was performed occasionally at the bleeding points. However, high fever and hematuria persisted for seven months, at which time CSII was started. The basal rate of insulin infusion was one unit per hour, and each pre-prandial bolus dose was four to 12 units. Thereafter, the diabetic control was improved; the hemorrhagic cystitis was also improved six weeks after starting CSII without any recurrence of high fever or macrohematuria. She was discharged in September 1981.
After discharge, the patient continued CSII under the self-monitoring of blood glucose. Her diabetic control has been very good, she is free from high fever and hematuria, and the peripheral neuropathy is improved.
During the course, no mechanical trouble developed in connection with CSII and no local pain or swelling has been observed.
