Remission of insulin resistant diabetes in two patients with anti-insulin receptor antibodies.

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Abstract
Two diabetic patients with anti-insulin receptor antibodies, associated with either acanthosis nigricans or systemic lupus erythematosus, are reported. Remission occurred 15 mo. after the onset of insulin resistant diabetes. One patient unfortunately died of acute pneumonia and the other was followed up. The anti-insulin receptor antibodies were measured according to the method of Omori and Hirata by using the pellet of human placental membrane. The anti-insulin receptor antibodies in both cases diminished as remission occurred. Reverse hemolytic plaque assay (PFG) detected Ig-producing cells. In the 2nd case, the plaque-forming cells were 20 times as many as the normal value. Immunosuppressive therapy with cyclophosphamide reduced the Ig secreting cells as remission occurred. The patients with insulin resistance (type B) should be treated with enough insulin inspite of the presence of insulin resistance. Besides, cyclophosphamide, 6-mercaptopurine and prednisolone should be used with caution. Plasma exchange is a treatment to be tried. Spontaneous remission may occur more than half a year after the onset of insulin resistant diabetes.