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[Hyperglycemic hyperosmolar non-ketotic diabetic coma with prolonged insulin-resistnace and extremely high values of
Abstract:
The paper reports the occurrence - over a period of some days - of a hyperosmolar non ketotic coma, with prolonged relative insulin-resistnace in a micro- and macroangiopathic long term diabetic subject, after infection and minor surgery. The patient was on oral hypoglycemic treatment during the past 11 years; previously he had been treated with Protamin Zinc Insulin. The case is characterized by extremely high values of Insulin-IgG-binding (12 MU/ml), which still further increased to 20 mU/ml when an emergency insulin management was recommenced, perhaps as the result of an immunogenic booster effect. A diagram of underlying and precipitating conditions likely to lead to diabetic non-ketotic coma is presented. Exogenous anti-insulin immunitary factors are postulated as exceptional condidates for inclusion.
Insights
A long-term diabetic patient experienced hyperosmolar non-ketotic coma and insulin resistance after infection and surgery. High Insulin-IgG binding levels increased with emergency insulin treatment, suggesting an immune response.
Area of Science:
- Endocrinology
- Immunology
- Metabolic Disorders
Background:
- Presents a case study of a long-term diabetic individual with micro- and macroangiopathy.
- Details a history of oral hypoglycemic agents and prior Protamin Zinc Insulin treatment.
Observation:
- Reports the occurrence of hyperosmolar non-ketotic coma over several days.
- Notes prolonged relative insulin resistance in the patient.
- Documents extremely high Insulin-IgG binding levels (12 MU/ml), escalating to 20 mU/ml during emergency insulin therapy.
Findings:
- The increased Insulin-IgG binding suggests a potential immunogenic booster effect from emergency insulin management.
- Highlights the role of infection and minor surgery as precipitating factors.
- Postulates exogenous anti-insulin immunitary factors as potential contributors.
Implications:
- Suggests a need to consider immune-mediated factors in managing complex diabetic emergencies.
- Provides a diagram illustrating conditions leading to diabetic non-ketotic coma.
- Underscores the challenges in treating long-term diabetics with superimposed immune responses.