The third and sixth cranial nerves are most frequently affected in diabetic extraocular mononeuropathies. In diabetic oculomotor involvement the pupil is undisturbed. Of the 21 patients of diabetic oculomotor paralysis 4 patients (19 percent) had dilated unreactive pupil suggestive of pupillomotor involvement. No other cause could be attributed to oculomotor paralysis. These patients showed complete but slow resolution as compared to those without pupil involvement.
Four episodes of transient severe insulin resistance in diabetic ketoacidosis, possibly of immunological origin, have been described. Severe insulin resistance was diagnosed when insulin requirement exceeded 100 units per hour. Treatment comprised of doubling the insulin dose intravenously every two hours till there was a satisfactory response and administration of steroids when 100 units per hour of insulin were being administered. Contrary to the usual response, ketosis responded first followed by hyperglycaemia. When insulin resistance was overcome, plasma glucose continued to fall despite witholding insulin and late hypoglycaemia occurred in three episodes.
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