An obese woman was studied over a five-year period, during which time she had three episodes of severe insulinresistant diabetes, associated with a high level of insulin antibodies.
During her second hospitalization, there was no evidence of acute stress, suggesting that in addition to obesity, her extremely high levels of antibodies were interfering with the effectiveness of the administered insulin. These antibodies were shown by immunologic methods to bind both circulating exogenous (bovine) and endogenous (human) insulins. With no other specific therapy except the abrupt halt of insulin, her diabetes improved, her antibody liters declined with a half-life of about twenty days, and the capacity of her plasma to bind both exogenous and endogenous insulin decreased. Antibody levels, although much lower, were still detectable more than eighteen months after discontinuing insulin therapy.
The patient's marked clinical improvement on stopping insulin, suggested that the high levels of circulating antibodies were a factor in maintaining her severe insulin resistance. Treatment with insulin in this patient was not only ineffective but apparently had worsened her diabetes. The excellent results obtained during her third hospitalization emphasize the superiority of supervised diet and enforced weight reduction over insulin as a choice of treatment in this type of patient.
