Kaitlin Pruskowski, BCCCP, BCPS, PharmD
Clinical Pharmacist, Burn Critical Care
US Army Institute of Surgical Research
Fort Sam Houston, Texas
Disclosure information not submitted.
Garrett Britton, DO
Intensivist
US Army Institute of Surgical Research, United States
Disclosure information not submitted.
Title: Liraglutide for insulin resistance after burn injury
Case Report Body:
Introduction: Hypermetabolism, manifested as hyperglycemia and insulin resistance, is common after severe burn injury. Oftentimes, patients require high doses of insulin to maintain blood glucose (BG) between 140 and 180 mg/dL. Adjunctive therapies typically used in patients with type 2 diabetes mellitus have not widely been studied in this patient population. Additionally, renal dysfunction or failure is commonly encountered after severe burn injury, which limits non-insulin options for insulin resistance. Liraglutide is an incretin mimetic and exerts its action by promoting glucose-dependent insulin secretion and decreasing glucagon secretion. We present a case where liraglutide was used for insulin resistance after severe burn injury.
Description: A 58 year-old male was admitted after sustaining 34% TBSA burns. The patient did not have a history of type 2 diabetes mellitus and had a hemoglobin A1C of 5.6% on admission. Throughout his stay, the patient required high amounts of intravenous insulin, up to 1327 units/day to maintain BG levels within goal. On ICU day 6, sitagliptin was added to help improve BG control. Early in this patient’s hospital stay, he developed an acute kidney injury (AKI), requiring the initiation of continuous renal replacement therapy (CRRT) on ICU day 13. The patient did not show signs of renal recovery, was eventually transitioned to intermittent hemodialysis (IHD) (ICU day 96). On ICU day 92, the patient still required high amounts of insulin (160 units/day). Liraglutide 0.6mg subcutaneously daily was added on hospital and ICU day 93. Within one day, the patient was able to be transitioned off of an insulin infusion. On day two of liraglutide therapy, the patient required 23 units of insulin (19 from infusion and 4 units sliding scale insulin). On day three of liraglutide therapy, the patient required 14 units of sliding scale insulin. During this time, the patient’s dietary intake of carbohydrates did not significantly change.
Discussion: Insulin resistance is common after severe burn injury. Non-insulin medications are not well-studied in this patient population. For patients with renal failure, non-insulin adjuncts are limited. Liraglutide may be an option to help liberate burn patients from insulin infusions and transition to lower levels of care. Further investigation is warranted.