Diabetes due to secretion of an abnormal insulin
BD Given, ME Mako, HS Tager… - … England Journal of …, 1980 - Mass Medical Soc
BD Given, ME Mako, HS Tager, D Baldwin, J Markese, AH Rubenstein, J Olefsky…
New England Journal of Medicine, 1980•Mass Medical SocAbstract A 51-year-old, nonobese man with diabetes mellitus had marked hyperinsulinemia
(70 to 120 μU per milliliter; 502 to 860 pmol per liter) and fasting hyperglycemia (140 to 170
mg per 100 ml; 7.8 to 9.4 mmol per liter). Plasma proinsulin, glucagon, growth hormone, and
cortisol levels were normal; insulin antibodies and insulin-receptor antibodies were not
detected. The patient showed relatively normal insulin sensitivity, and insulin receptors on
circulating monocytes were within the normal range. Insulin from the patient's serum bound …
(70 to 120 μU per milliliter; 502 to 860 pmol per liter) and fasting hyperglycemia (140 to 170
mg per 100 ml; 7.8 to 9.4 mmol per liter). Plasma proinsulin, glucagon, growth hormone, and
cortisol levels were normal; insulin antibodies and insulin-receptor antibodies were not
detected. The patient showed relatively normal insulin sensitivity, and insulin receptors on
circulating monocytes were within the normal range. Insulin from the patient's serum bound …
Abstract
A 51-year-old, nonobese man with diabetes mellitus had marked hyperinsulinemia (70 to 120 μU per milliliter; 502 to 860 pmol per liter) and fasting hyperglycemia (140 to 170 mg per 100 ml; 7.8 to 9.4 mmol per liter). Plasma proinsulin, glucagon, growth hormone, and cortisol levels were normal; insulin antibodies and insulin-receptor antibodies were not detected. The patient showed relatively normal insulin sensitivity, and insulin receptors on circulating monocytes were within the normal range.
Insulin from the patient's serum bound to IM-9 lymphocytes and rat adipocytes approximately 40 per cent as well as insulin standards. Its biologic activity on rat adipocytes averaged 15 per cent of that expected from its immunologic concentration.
The impaired biologic activity of this patient's circulating insulin was probably due to a structural abnormality. Subsequent studies of the patient's insulin (fortuitously obtained from his pancreas during a laparotomy for a pancreatic cyst) have confirmed this conclusion. (N Engl J Med 302:129–135, 1980)
The New England Journal Of Medicine