Hyperlabile diabetes accompanied by insulin resistance.

1981 ◽  
Vol 27 (8) ◽  
pp. 1463-1464 ◽  
Author(s):  
A Renie ◽  
R G Hamilton ◽  
N F Adkinson ◽  
M S Rendell
Keyword(s):  
Insulin Resistance ◽  
Solid Phase ◽  
Insulin Requirement ◽  
Porcine Insulin ◽  
Insulin Antibody ◽  
Insulin Dosage ◽  
Diabetic Patients ◽  
Free Insulin ◽  
High Insulin ◽  
Solid Phase Radioimmunoassay

Abstract It is generally held that high insulin antibody concentrations, by "buffering" abrupt swings in free insulin concentrations after injections of exogenous insulin, tend to stabilize blood glucose variations in diabetic patients. However, we encountered a patient with extremely labile diabetes coexisting with insulin resistance. This patient's injections were switched to pure porcine insulin from his usual mixed bovine/porcine insulin, in an effort to decrease his insulin requirement. This treatment was successful, and, as his insulin dosage decreased, his diabetic lability diminished substantially. His diabetes was eventually considered stabilized on about 22 units of porcine insulin daily. The serial decrease in his insulin antibody concentrations, monitored by use of solid-phase radioimmunoassay, paralleled the disappearance of his diabetic lability as well as the decrease in his insulin requirement.

scholarly journals Extremely high-dose insulin requirement in a diabetic patient with COVID-19: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
François R. Jornayvaz ◽  
Benjamin Assouline ◽  
Jérôme Pugin ◽  
Karim Gariani
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Patient ◽  
Insulin Requirement ◽  
Diabetic Patients ◽  
High Dose ◽  
Intravenous Insulin ◽  
Patients With Diabetes ◽  
Mechanical Ventilation Support ◽  
High Insulin

Abstract Background Detailed description of hyperglycemia management in diabetic patients infected with SARS-CoV-2 remain limited, although patients with diabetes show higher complication and mortality rate than patients without diabetes. Transient non-severe increased insulin requirement in patients hospitalized for medical conditions such as sepsis or myocardial infarction is a well-known phenomenon. However, extremely high-dose insulin requirement remains a very rarely reported entity. Here, we report the case of an extreme and transitory insulin requirement episode in a type 2 diabetic patient presenting an acute respiratory distress syndrome caused by SARS-CoV-2. Case presentation A 57-year-old man resident in Geneva, Switzerland, previously known for type 2 diabetes for 3 years was admitted for an aggravation of his dyspnea. His type 2 diabetes was treated only with metformin and his latest Hb1Ac was 6.1%. Chest CT SCAN showed a bilateral multilobar ground-glass opacification. Twenty-four hours after his admission he presented a worsening of dyspnea and severe hypoxemia requiring a transfer to the intensive care unit rapidly followed by oro-tracheal intubation for mechanical ventilation support. A bronchoalveolar lavage was performed and test of SARS-CoV-2 by RT-qPCR assay was positive. At day 3, he presented a rapidly progressive insulin requirement at a rate of up to 50 units/hour intravenous insulin aspart. Despite the high insulin doses, he maintained an elevated plasma glucose level at 270 mg/dL on average. His extremely high-dose insulin requirement “resolved” at day 9, and the insulin infusion rate was rapidly reduced. Conclusions This case may reflect a specific and profound impact of SARS-CoV-2 on metabolic homeostasis, in particular in diabetic patients that appear more prone to complications of COVID-19 infection. Yet, the mechanisms behind this remain to be elucidated. The optimal management of hyperglycemia of diabetic patients infected with SARS-CoV-2 has yet not be defined, however insulin remain the mainstay of treatment approach. Report of extreme dysregulation of chronic conditions such as diabetes in patients with COVID-19 may help clinicians to better take care of patients during the pandemic of SARS-CoV-2. To the best of our knowledge this is the first description of extremely high-dose insulin requirement in patient with COVID-19.

scholarly journals Extreme High Insulin Requirements in Two Non-Diabetic Patients Following Cardiac Transplantation

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A383-A383
Author(s):  
Priyadarshini Balasubramanian ◽  
Christi Moreau ◽  
Tariq Ahmad ◽  
Silvio E Inzucchi
Keyword(s):  
Insulin Resistance ◽  
Blood Glucose ◽  
Cardiac Transplantation ◽  
Acute Decompensated Heart Failure ◽  
Prior History ◽  
Diabetic Patients ◽  
High Dose ◽  
Baseline Hba1c ◽  
Insulin Requirements ◽  
High Insulin

Abstract Introduction: Blood glucose (BG) management is challenging following cardiac transplantation (CT) due to insulin resistance (IR) induced by post-operative stress and inflammation, intravenous pressors, and high-dose steroids. Severe IR manifested by extreme insulin requirements is rare. We report 2 such patients without prior history of diabetes (DM) requiring massive doses of IV insulin in the immediate post-op period. Patient 1: A 59 y/o male with hypertrophic cardiomyopathy (CM) presented with symptoms of acute decompensated heart failure and ultimately underwent orthotopic CT. At baseline, HbA1c was 5.8% and BMI 23 kg/m2. Exam was significant for acanthosis nigricans. He received 1g IV methylprednisolone (MP) during surgery and 125 mg IV Q 8 hours subsequently. His blood glucose (BG) immediately post-op was 312 mg/dL and was started on IV insulin. Despite doses up to 93 U/hr, BG remained >300mg/dl. With steroid taper, insulin requirements declined rapidly. He was transitioned to small dose of insulin glargine and was discharged on metformin monotherapy with near-normal BGs. Patient 2: 49 y/o male with a genetic CM was admitted for elective orthotopic CT. At baseline, HbA1c was 5.8% and BMI 32 kg/m2. Exam was significant for central obesity. He received similar doses of IV MP as patient 1 but also required inotropes (dobutamine, epinephrine, milrinone mixed in 5% dextrose containing fluids.) His BG immediately post-op was 284 mg/dL and was started on IV insulin. Despite doses up to 85 U/hr, BG remained >250 mg/dl. With steroid taper, insulin requirements resolved rapidly and he was discharged with normal BGs off all DM agents. Pseudo insulin resistance (i.e. line occlusion or erroneous IV insulin solution concentration) was excluded in both cases. Conclusion: Although many patients require high insulin doses after CT, rarely are infusion rates as high as in our patients achieved, particularly in non-diabetic individuals. We propose that it was the combination of underlying IR/prediabetes, counter-regulatory hormones, proinflammatory cytokines, increased lipolysis, with exogenous steroids and catecholamine-based inotropic agents that resulted in extreme inhibition of insulin action. However, because this combination of factors is not necessarily rare in post-CT patients, other factors must have been at play and will remain to be elucidated. From a pragmatic standpoint, because of rapid decrease in BG levels as steroids were tapered, we recommend very close follow-up of such patients with rapid decreases in insulin infusion rates as necessitated by trends in prevailing glycemia to prevent hypoglycemia. It would also be helpful to target a slightly higher glucose goal in such patients to prevent subsequent hypoglycemia.

scholarly journals High Insulin Requirements and Poor Metabolic Control do not Modify the Expression, Regulation and PKC Mediated Activation of the p21ras Pathway in PBMC from Type II Diabetic Patients

2001 ◽  
Vol 2 (1) ◽  
pp. 47-54
Author(s):  
M. J. Rapoport ◽  
O. Levi ◽  
M. Weiss ◽  
A. Buchs ◽  
Y. Ramot ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Control ◽  
Type Ii Diabetes ◽  
Expression Regulation ◽  
Diabetic Patients ◽  
Type Ii ◽  
Severe Insulin Resistance ◽  
Poor Metabolic Control ◽  
Insulin Requirements ◽  
High Insulin

AimsTo asses whether clinically severe insulin resistance and poor metabolic control in patients with type II diabetes are associated with aberrant expression or function of the p21ras pathway.MethodsWe examined the expression and function of the p21ras pathway in resting and activated PBMC from 10 insulin treated patients with type II diabetes characterized by high insulin requirements and poor metabolic control (IR group) and 10 age and sex matched well controlled patients treated by diet alone or oral hypoglycemic medications (WC group).ResultsLevels of p21ras and its regulatory elements: p21rasGAP and hSOS1, were comparable in the two groups. The induced activities of p21ras and its associated down-stream regulatory enzyme MAP-kinase following TPA stimulation were also comparable in the IR and WC patients.ConclusionsTaken together, these data indicate that clinically significant severe insulin resistance does not modify the expression, regulation and activation of p21ras pathway in PBMC of patients with type II diabetes.

scholarly journals Categorization of β-cell capacity in patients with obesity via OGTT using K-means clustering

2020 ◽  
Vol 9 (2) ◽  
pp. 135-143 ◽  
Author(s):  
Li Li ◽  
Qifa Song ◽  
Xi Yang
Keyword(s):  
Insulin Resistance ◽  
Insulin Release ◽  
Insulin Response ◽  
Older Age ◽  
Diabetic Patients ◽  
Clustering Method ◽  
Glucose Levels ◽  
Group 4 ◽  
High Insulin ◽  
Group 2

Insufficient insulin release plays a crucial role in the development of unhealthy status in patients with obesity; the present study aimed to classify these patients by the indices for insulin resistance and insulin release. After the indices from OGTT were assessed to achieve high differentiability and low redundancy in classifying patients, HOMA-IR and IGI30min were chosen to classify the patients using K-means clustering method. A total of 249 non-diabetic patients with obesity were classified into four groups. In Group 1, 19 patients were characteristic of high insulin resistance and high insulin release, as well as well-controlled glucose levels, the highest BMI, the youngest age, and the highest early phase release of insulin. In Group 2, 38 patients were unhealthiest in terms of high insulin resistance, reduced insulin release and IGT status. Group 3 consisted of 63 patients that were healthiest with low insulin resistance and high insulin release. In Group 4, 46 IGT patients and 14 IFG patients were identified among 129 patients that showed low insulin resistance, low insulin release, moderate obesity and older age. These concurrent impotent insulin release, older age, and moderate obesity indicated decreasing obesity with increasing age and reduced insulin release. The classification of patients with obesity using K-means clustering method by HOMA-IR and IGI30min provides more information about the development of obesity and unhealthy status. The patients with distinct insulin resistance and insulin release should be followed up, especially for those with reduced or even absent insulin response to glucose stimulation.

Radioimmunoassay of Fibrinogen and Its Proteolysis Products

1968 ◽  
Vol 20 (01/02) ◽  
pp. 001-006 ◽  
Author(s):  
K. J Catt ◽  
J Hirsh ◽  
D. J Castelan ◽  
H. D Niall ◽  
G. W Tregear
Keyword(s):  
Solid Phase ◽  
Solid Phase Radioimmunoassay ◽  
Radioimmunoassay Method

SummaryThe solid-phase radioimmunoassay method has been applied to the measurement of fibrinogen. The method is extremely sensitive, being able to detect fibrinogen concentrations as low as 10 ng/ml. The immunoreactivity of fibrinogen proteolysis products differs from that of native fibrinogen, early proteolysis products showing enhanced immunoreactivity which decreases progressively with further digestion.

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