THE MYSTERY OF 1200 UNITS OF INSULIN PER DAY

Context: Insulin autoimmune Syndrome is an extremely rare cause of both hyperglycemia and hypoglycemia. Ketoacidosis in type 2 diabetes mellitus presenting as Insulin Autoimmune syndrome is also rare. It is difficult to treat and no protocols exist for its treatment. Steroid therapy has been tried with some success and other immunosuppressants may have a role.

Case Report: Herein, we report a 74-year-old male presenting with ketoacidosis, requiring 1200 units insulin per day and still no decline in blood sugar levels. His Insulin autoantibodies were strongly positive and he had dramatic response to steroids. This report is the first case of insulin autoimmune syndrome presenting with hyperglycemia and diabetic ketoacidosis, in India, requiring more than1000 units of insulin.

Conclusion: Insulin auto antibody syndrome should be considered in the differential diagnosis of unexplained hyperglycemia or hypoglycemia. An elevated insulin antibody titer in a patient not previously exposed to insulin, helps to clinch this rare condition.