Intermittent need for insulin in a subgroup of diabetic patients in Tanzania

Twenty-nine African patients regularly attending a diabetic clinic in northern Tanzania had a remarkable fluctuating clinical course. Initially the majority were stabilized on insulin, but after varying periods they no longer needed insulin and could be treated with oral hypoglycaemic agents. Acute infective illnesses occurring in these patients while they were on oral treatment did not necessitate insulin therapy. In a few patients even oral treatment was discontinued and dietary management was adequate. Ketoacidosis or other complications were rarely seen. However, insulin treatment had to be restarted in several patients without any precipitating factors such as stress, infection or pregnancy because diabetic symptoms became severe and the blood glucose levels were high. These episodes were temporary and the treatment regimens could again be changed later. Thus, a remarkable unpredictability regarding treatment regimens was seen. The patients were all over 25 years of age and there was a male preponderance. It is suggested that these patients cannot be classified as having either insulin-dependent or non-insulin-dependent diabetes.