Severe insulin resistance in a patient with type 1 diabetes and stiff-man syndrome treated with insulin lispro.

Journal Article (Journal Article)

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 HbA1c 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.

Full Text

Duke Authors

Cited Authors

  • Hirsch, IB; D'Alessio, D; Eng, L; Davis, C; Lernmark, A; Chait, A

Published Date

  • September 1998

Published In

Volume / Issue

  • 41 / 3

Start / End Page

  • 197 - 202

PubMed ID

  • 9829349

International Standard Serial Number (ISSN)

  • 0168-8227

Digital Object Identifier (DOI)

  • 10.1016/s0168-8227(98)00072-2


  • eng

Conference Location

  • Ireland