INSULIN-RESISTANT DIABETES ASSOCIATED WITH INCREASED ENDOGENOUS PLASMA INSULIN FOLLOWED BY COMPLETE REMISSION

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Abstract
The case of an 18-year-old Negro female diabetic with severe insulin unresponsiveness, is presented. Over a period of 18 months there was a complete remission of both her insulin resistance and her diabetes. Unique features of the case include the presence of large amounts of circulating endogenous insulin which appeared to have full physiologic activity in the isolated rat hemidiaphragm and the fasted mouse at a time when she was unresponsive to the hormone. Its identification as insulin was based on its ability to increase in vitro muscle glycqgen deposition as well as glucose uptake by rat diaphragm. In addition, its effect could be abolished by the addition of insulin antagonist plasma. While 90% of an injected tracer dose of insulin-I131 disappeared from the plasma in 48 hours, there was no change in the plasma insulin level during this time. Fractionation of the plasma indicated that most of the insulin activity resided in the inter-Y-B-globulin zone, although there was also a small amount migrating just behind albumin. Adipose tissue obtained from the patient demonstrated no increase in glucose uptake in the presence of 0.1 and 0.5 U insulin per ml, while normal adipose tissue from other diabetics responded to the latter concentration. In the presence of 1 Unit per ml insulin, her adipose tissue demonstrated a normal response.