Studies are reported of a twenty-five-year-old woman with insulin resistance. Daily insulin dosage fluctuated, ranging from zero to a maximum of 177,500 units on one day. Associated conditions were acanthosis nigricans, multiple infections, cerebellar infarction, renal vein thrombosis, and chronic nephritis. Plasma obtained during resistance to large insulin dosage yielded high insulin content by immunoassay, high insulin-like activity by rat diaphragm, fat pad and mouse hypoglycemia assays, and no excessive binding capacity by the cellulose-trapping method. Plasma obtained after forty-two days without insulin treatment caused glycogen synthesis in the rat diaphragm. The cause of the resistance was unknown.

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