Insulin Resistance Developing in Children with IDDM

In a review of the 1000 children with insulin-dependent diabetes mellitus (IDDM) followed at The Hospital for Sick Children, Toronto, between 1970 and 1980, insulin resistance (IR) was noted in 3 after initial sensitivity to exogenous insulin. One was an otherwise typical patient with IDDM. One had cystic fibrosis and is the first such patient with IR to be reported. These two had high insulin antibody titers and responded dramatically to sulfated insulin. The third patient had hyperthyroidism. Although she also had a high anti-insulin antibody titer, IR was controlled only when she was given propylthiouracil. She is the first reported child with IR and hyperthyroidism. The literature on IR in children with IDDM is reviewed. With our 3 patients included, a total of 29 children have been reported. Their meanage is 12.9 yr, 72% are female, and 41% had associated illnesses. Insulin antibodies were elevated in 71% of those in whom measurement was attempted. Of those whose outcome is reported, 67% improved, 21% continued to have IR, and 12% died.