We review the literature on the pathophysiology and clinical features of type B insulin resistance syndrome and highlight the complexities and recent advances in the management of this disorder.
We report a case of severe type B insulin resistance syndrome complicated by severe diabetic ketoacidosis soon after the initial diagnosis of diabetes, despite large doses of exogenous insulin therapy. Our patient achieved euglycemic remission after combination immunomodulation. This case illustrates the severe catabolic state that may occur with high anti-insulin receptor antibody titers and that combination therapy with rituximab and dexamethasone, followed by maintenance azathioprine therapy for 1 year, is an effective treatment approach for the management of type B insulin resistance syndrome.
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