Subsequently there was in addition evidence of reduced insulin sensitivity. In type 2 diabetes insulin production is present but is insufficient to meet the bodys requirements as a result of end organ insulin resistance.
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The concept of insulin resistance in ketoacidosis stems from the old observation that the small dose of insulin that rapidly produces hypoglycemia in normal subjects has little.
Insulin resistance ketoacidosis. The rapidly increasing requirement of insulin 1600 units daily given by continuous. A diabetic woman presented with diabetic ketoacidosis after demonstrating immediate type hypersensitivity to heterologous insulin. Syndromes of severe insulin resistance ir include mutations of or autoantibodies to the insulin receptor and lipodystrophy.
If dka occurs in someone with type 2 diabetes their condition is called ketosis prone type 2 diabetes. But diabetic ketoacidosis can also occur in relative insulin deficiency when insulin is present in the body but high levels of counter regulatory hormones cause increased insulin resistance. In the ketoacidotic patients a history of prior insulin therapy but not the degree of hyperglycemia at the time of admission was associated with a more rapid rate of decline of plasma glucose in response to insulin treatment.
Usually these amounts of insulin are sufficient to suppress ketogenesis. A 14 year old female patient with insulin resistance is reported in whom it appeared that initially insulin breakdown was unusually rapid. Anaphylaxis and immunologic insulin resistance in a diabetic woman with ketoacidosis.
Ross jm murali mr delara tc cheron rg. Cuthbert c alberti kg. She had had interrupted insulin therapy in the past.
Insulin was infused at doses ranging from 003 to 100 ukghr and dose response curves established. Insulin sensitivity with respect to changes in blood glucose lactate and ketone body concentrations has been studied in normal and streptozotocin diabetic rats. This kicks off a feedback loop of increasing blood sugar and ketosis that will lead to dka if not treated immediately.
The main purpose of this paper is to review the literature to identify the underlying mechanisms of extreme insulin resistance in a patient with dka and mi. Acidemia and insulin resistance in the diabetic ketoacidotic rat. We conclude that marked insulin resistance is present in virtually all diabetics in ketoacidosis.
Here we report a case of prolonged course of extreme insulin resistance in a patient admitted with diabetic ketoacidosis dka and acute myocardial infarction mi. Diabetic ketoacidosis dka although rare can occur in these patients even in the context of hyperinsulinemia due to impaired insulin signaling.