Case 58: Extreme Insulin Resistance Following Heart Transplant

A 60-year-old Caucasian woman presented with 2 weeks of worsening fatigue and shortness of breath. Past medical history revealed adriamycin-induced cardiomyopathy, for which she required a left ventricular assist device (LVAD) and a subsequent heart transplant. She did not have a history of diabetes. Her blood glucose (BG) average 3 months before the transplant was 112 ± 30 mg/dL (6.2 ± 1.7 mmol/L). Her preoperative glucose was 80 mg/dL (4.4 mmol/L) and her intraoperative BG levels ranged from 95 to 342 mg/dL (5.2–19 mmol/L). There were no complications during surgery. She received a single dose of 500 mg of intravenous (i.v.) methylprednisone intraoperatively.