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

Summary

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.

Key-Words

Severe Insulin Resistance - Diabetic Ketoacidosis - Insulin Steroids - Late Hypoglycaemia