Spontaneous Disappearance of Insulin-Resistant Diabetes Mellitus in a Patient with a Collagen Disease; A Case Report, with Review of the Literature for Conditions Associated with Insulin Resistance

Abstract

Insulin resistance causing insulin requirements greater than 1,000 units a day is reported in a 39-year-old woman with signs and symptoms of a collagen disease. After ten months insulin resistance regressed and glucose tolerance and insulin sensitivity returned to normal. A review of the literature indicates that this is only the second well-documented case of disappearance of diabetes. The conditions associated with insulin resistance and the possible causes of insulin resistance in this patient are discussed.

Case Details

Personal Characteristics

39-year-old negro housewife, had four children, delivered an erythroblastotic child in 1959 and a stillborn child at six months gestation in 1966, no past history of arthritis, asthma, endocrine, hepatic, renal or skin disease, no relatives had diabetes mellitus, allergic disease or collagen diseases

Clinical Characteristics

Weakness, fatigability, palpitations and dyspnea on exertion, weight loss, urinary frequency and nocturia, pain in right shoulder, dryness of mouth, hair growth over the temples, chronic rash with dryness, crusting and pruritus over her face and scalp, pain in fingers associated with blanching on exposure to cold, cholelithiasis, seborrheic eruption involving the face and scalp, eczematoid eruption involving the neck, submaxillary glands were enlarged and nontender, hands blanched on immersion in cold water and after exercise, cervical lymph nodes were slightly enlarged and nontender, blood glucose was 267 mg%, blood urea nitrogen 10.2 mg%, uric acid 2.6 mg% serum sodium 130 meq/l, potassium 4.0 meq/l, carbon dioxide capacity 20 meq/l and chloride 105 meq/l, positive for rheumatoid factor, increase in IGG and IGM with normal IGA and complement levels, bone marrow aspirate was hypocellular with moderate erythroid hyperplasia, biopsy of a cervical node showed atypical reticuloendothelial hyperplasia, skin biopsy specimens showed minimal and nonspecific changes, insulin antibodies were present, blood glucose levels ranged from 210 to 249 mg% with persistent 3+ to 4+ glycosuria and variable acetonuria, erythema over the malar areas of her face and dorsum of her phalanges, patchy hyperpigmentation over the upper part of her chest, hypopigmentation and telangiectases of her cuticles, and small stellate scars on her finger tips, submaxillary glands are smaller and firmer, liver function studies are within normal limits except for persistent hyperglobulinemia

Remission Characteristics

Insulin resistance regressed and glucose tolerance and insulin sensitivity returned to normal, a year later she was still symptomfree without medication or diet

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Insulin therapy, prednisone, tolbutamide, pork insulin, 1,800 calorie diabetic diet, 3,000 calorie diabetic diet

Additional Notes

This is only the second well-documented case of disappearance of diabetes