Transient Severe Insulin Resistance in Diabetic Ketoacidosis(A Report of Four Episodes)

Abstract

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.

Transient Extreme Insulin Resistance in Shoch during Diabetic Ketoacidosis.

“…In the majority of cases, however, continuous infusion of low-dose insulin up to 10 units h-1 is described to be safe and effective in the treatment of DKA [3,4]. Severe insulin resistance requiring more than 100 units h-1 is exceedingly rare [5,6]. We encountered a case of DKA with shock, which required an extremely large dose of insulin: 91,580 units over a 25-h period, for resolution.…”