Insulin chromium requirement

A 54-year-old woman with gestational diabetes was later found to be allergic to chromium, pollen, dust, penicillin, acarbose, and metformin (130). She was treated with diet and glibenclamide, but later required insulin. With Humulin N insulin she developed a wheal of 15 mm immediately after the injection, which resolved in a few hours. However, a painful itchy induration appeared 2-3 hours after the injection and lasted a few days. She had an immediate reaction to isophane insulin, with induration, but insulin lispro was well-tolerated. 

Chromium(III) is an essential nutrient required for normal energy metabolism. The National Research Council (NRC) recommends a dietary intake of 50-200 ig/day (NRC 1989). The biologically active form of an organic chromium(ni) complex, often referred to as GTF, is believed to function by facilitating the interaction of insulin with its cellular receptor sites. The exact mechanism of this interaction is not known (Anderson 1981 Evans 1989). Studies have shown that chromium supplementation in deficient and marginally deficient subjects can result in improved glucose, protein, and lipid metabolism. 

Chromium in the urine—Normally, only small amounts of chromium are excreted in the urine. However, the administration of a test dose of glucose usually causes a marked increase in the amount of the mineral in the urine, unless the patient happens to be chromium deficient Hence, the use of this test requires that the urine be collected and analyzed for chromium content both before and after the administration of the sugar. The test is not valid for diabetics who require injections of insulin, because they usually excrete abnormally high amounts of chromium in the urine. 

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