Complete Remission Of Severe Diabetes

Abstract

The findings are reported in a 41-year-old male admitted to the hospital on October 12, 1954, in severe diabetic coma. There was no history of diabetes until the onset of illness one day before admission, when he was found unconscious. On admission, the blood sugar was 1,280 mg%, Carbon dioxide was 3 mEq, the Rabinowitch Severity Index was 24, and the patient was in circulatory collapse. Nineteen hundred and ten units of insulin were administered during the next twelve hours, and subsequently insulin resistance developed requiring 200 to 400 units of insulin daily in order to maintain normal glycemia. After approximately ten days in the hospital responsiveness to insulin suddenly improved and severe hypoglycemia ensued. Regulation was then established with 90 units of NPH insulin, which was reduced to 30 units daily until November 27, 1954, when insulin was entirely discontinued and the patient’s blood sugars remained normal. Intensive study of the patient’s endocrine and metabolic status subsequently disclosed no significant abnormalities, and clinical evidence of diabetes is not revealed even to the provocative cortisone glucose tolerance test of FajansConn. The case represents an unusual instance of temporary severe diabetes accompanied by coma and acidosis with apparently complete recovery as far as can now be determined. Until a five-year period has elapsed, it should be regarded as a remission rather than a cure.