Severe insulin resistance in a patient with type 1 diabetes and stiff- man syndrome treated with insulin lispro
Hirsch, Irl B. ; D'Alessio, David ; Eng, Lily ; Davis, Connie ; Lernmark, Åke LU
and Chait, Alan
(1998)
In Diabetes Research and Clinical Practice
41(3).
p.197-202
- Abstract
We describe a patient with type 1 diabetes with recurrent diabetic ketoacidosis and severe insulin resistance. Extensive evaluation of the etiology of the insulin resistance did not reveal an etiology, and well over 1000 U of daily insulin did not prevent the ketoacidosis. Her blood glucose and insulin requirements were improved with glucocorticoids and octreotide, but the effects of both of these agents were short-lived. She was given a trial of insulin lispro with immediate and dramatic effects, lowering her HbA(1c) from 14.6 to 5.1% in 7 months with a decrease in insulin requirements of 1600-100 U per day. Besides her diabetes, she had a history of pain and stiffness affecting numerous muscle groups, and hospitalization was required... (More)
We describe a patient with type 1 diabetes with recurrent diabetic ketoacidosis and severe insulin resistance. Extensive evaluation of the etiology of the insulin resistance did not reveal an etiology, and well over 1000 U of daily insulin did not prevent the ketoacidosis. Her blood glucose and insulin requirements were improved with glucocorticoids and octreotide, but the effects of both of these agents were short-lived. She was given a trial of insulin lispro with immediate and dramatic effects, lowering her HbA(1c) from 14.6 to 5.1% in 7 months with a decrease in insulin requirements of 1600-100 U per day. Besides her diabetes, she had a history of pain and stiffness affecting numerous muscle groups, and hospitalization was required for pain control. The diagnosis of stiff-man syndrome (SMS) was confirmed with high titers of glutamic acid decarboxylase 65 antibodies in both serum and cerebral spinal fluid. In summary, we describe the first patient with type 1 diabetes, SMS, and severe insulin resistance. Although the etiology of the insulin resistance is unknown, due to the efficacious response to insulin lispro, hydrocortisone, and perhaps octreotide, we propose an immune-mediated etiology. Although rare, this syndrome needs to be considered as an etiology of insulin resistance.
(Less)
- author
- Hirsch, Irl B.
; D'Alessio, David
; Eng, Lily
; Davis, Connie
; Lernmark, Åke
LU
and Chait, Alan
- publishing date
- 1998-09-01
- type
- Contribution to journal
- publication status
- published
- keywords
- Glucocorticoid, Insulin lispro, Insulin resistance, Octreotide, Stiff man syndrome
- in
- Diabetes Research and Clinical Practice
- volume
- 41
- issue
- 3
- pages
- 197 - 202
- publisher
- Elsevier
- external identifiers
-
- scopus:0032170174
- pmid:9829349
- ISSN
- 0168-8227
- DOI
- 10.1016/S0168-8227(98)00072-2
- language
- English
- LU publication?
- no
- id
- 16eee57a-7a30-40d1-a340-d172d6b5a15b
- date added to LUP
- 2019-06-30 23:40:46
- date last changed
- 2024-03-13 08:06:12
@misc{16eee57a-7a30-40d1-a340-d172d6b5a15b,
abstract = {{<p>We describe a patient with type 1 diabetes with recurrent diabetic ketoacidosis and severe insulin resistance. Extensive evaluation of the etiology of the insulin resistance did not reveal an etiology, and well over 1000 U of daily insulin did not prevent the ketoacidosis. Her blood glucose and insulin requirements were improved with glucocorticoids and octreotide, but the effects of both of these agents were short-lived. She was given a trial of insulin lispro with immediate and dramatic effects, lowering her HbA(1c) from 14.6 to 5.1% in 7 months with a decrease in insulin requirements of 1600-100 U per day. Besides her diabetes, she had a history of pain and stiffness affecting numerous muscle groups, and hospitalization was required for pain control. The diagnosis of stiff-man syndrome (SMS) was confirmed with high titers of glutamic acid decarboxylase 65 antibodies in both serum and cerebral spinal fluid. In summary, we describe the first patient with type 1 diabetes, SMS, and severe insulin resistance. Although the etiology of the insulin resistance is unknown, due to the efficacious response to insulin lispro, hydrocortisone, and perhaps octreotide, we propose an immune-mediated etiology. Although rare, this syndrome needs to be considered as an etiology of insulin resistance.</p>}},
author = {{Hirsch, Irl B. and D'Alessio, David and Eng, Lily and Davis, Connie and Lernmark, Åke and Chait, Alan}},
issn = {{0168-8227}},
keywords = {{Glucocorticoid; Insulin lispro; Insulin resistance; Octreotide; Stiff man syndrome}},
language = {{eng}},
month = {{09}},
number = {{3}},
pages = {{197--202}},
publisher = {{Elsevier}},
series = {{Diabetes Research and Clinical Practice}},
title = {{Severe insulin resistance in a patient with type 1 diabetes and stiff- man syndrome treated with insulin lispro}},
url = {{http://dx.doi.org/10.1016/S0168-8227(98)00072-2}},
doi = {{10.1016/S0168-8227(98)00072-2}},
volume = {{41}},
year = {{1998}},
}