Remarkable Sensitivity to Insulin in a Patient with Hypopituitarism and Diabetic Acidosis

A patient is described with panhypopituitarism and maturity-onset diabetes, complicated by diabetic acidosis. He exhibited a remarkable sensitivity to insulin, controlling his diabetes with an average of two units of insulin daily. He maintained increased sensitivity to insulin while in severe ketoacidosis and required only eight units of insulin to completely reverse this. Ketoacidosis does not directly result in insulin resistance, and it is possible that pituitary factors are essential. This case documents the importance of small basal levels of insulin in preventing ketoacidosis and lends further support to the concept that small levels of insulin serve as a “brake” on lipid mobilization. A delayed and prolonged response to insulin was observed in the panhypopituitary state.