Insulin Resistance in Diabetes Mellitus

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Abstract
A case of complete resistance to insulin is reported. This patient was given from 500-2460 U daily for a period of almost 4 mos. A search of the literature has revealed 20 cases of marked insulin resistance in diabetes mellitus. Exptl. observations indicated that although this patient was highly resistant to insulin, he nevertheless utilized insulin to some degree. Insulin-carbohydrate tolerance tests made with samples of blood taken at 1/2 hr. intervals demonstrated very little effect of the blood sugar despite very large doses of insulin given subcut. or intraven. A definite depression of the blood-sugar level was obtained when the intraven. dose of insulin was large enough (150 U). Insulin was demonstrated in the blood stream of the patient after its adm. Enough insulin to depress the blood sugar of a rabbit was present 15 mins. after inj. into the patient of insulin intraven. in one expt., but this effect had disappeared after 25 mins. A substance capable of elevating the blood-sugar levels of the rabbits was repeatedly demonstrated in the patient''s blood. This hyper-glycemic effect became more pronounced as the immediate effect of the insulin wore off. The data suggest that the phenomenon of insulin resistance, in this patient at least, was produced by the presence of an insulin antagonist. Whether this was identical with the hyperglycemic factor or whether it represented a separate fraction, was not detd.

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