Critical Survey of the Literature With the Report of a Case

A case of insulin resistant diabetes with possible antibodies to insulin receptors.

“…The previous proposal by Martin et al (1941) that insulin resistance exists when the insulin requirement exceeds200units per day for more than48hr in a nonketotic and non-infected diabetic patient, is still accepted. The most common type of insulin resistance is that associated with abnormal amounts of circulating antibodies against exogenous insulin.…”

The Role of Nonprecipitating Insulin Antibodies in Diabetes1

“…It was almost inevitable that once the existence of antibodies to insulin had been suggested, the effect of these on the insulin itself would be questioned. Studies performed on the serum of insulin resistant patients provided further impetus to the concept that antibodies to insulin inhibit the action of insulin, thus necessitating the use of of higher doses than would otherwise have been the case (1,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). In some instances the methods then available could demonstrate antibodies to insulin by direct skin testing, by passive transfer, by complement fixation or by the use of collodion particles (2,3,18,19).…”

“…7. Studies of the effect of selected plasma and added insulin on the blood sugar of animals (8,9,11,12,16,27).…”

Immunologic Studies in Insulin Resistance I. Report of a Case Exhibiting Variations in Resistance and Allergy to Insulin

“…Even with these very large doses, control of the diabetic state has not always been achieved. The subject of resistance to insulin has been reviewed recently (1). The high tolerance exhibited by these patients has been tenatively ascribed to lack of some factor necessary for the action of insulin, to endocrine imbalance or abnormality, to allergy, or to a neutralizing antibody.…”