Transient extreme insulin resistance in a critically ill patient: A case report

Table 1 Results of laboratory studies

Variables	Values	References
Antinuclear antibody	Negative	Negative
Peri-nuclear anti-neutrophil cytoplasmic antibody/cytoplasmic anti-neutrophil cytoplasmic antibodies (IU/mL)	0.3/0.5	< 5/< 3
C3/C4 (mg/dL)	60/12.5	83-193/15-57
Erythrocyte sedimentation rate (mm/hour)	60	0-20
Anti-double strand DNA antibody (IU/mL)	1.4	< 15
Others
Insulin (μIU/mL)1	> 600	< 17
C-peptide(ng/mL)1	18.22	0.78-5.19
Cortisol (8AM) (ug/dL)	19.9	3.7-19.4
Insulin-like growth factor 1 (ng/mL)	70.75	40-225
Human growth hormone (ng/mL)	0.55	< 6.6
Thyroid-stimulating hormone (mIU/L)	0.23	0.17-4.05

¹Obtained on day 14 with corresponding glucose level at 632 mg/dL and insulin infusion rate at 235 U/hour.

Table 2 Case reports of critically ill patients with extreme insulin resistance requiring an insulin infusion rate > 100 units/hour

Ref.	Age/sex	Diagnoses	Highest glucose level (mg/dL)	Target glucose range (mg/dL)	Peak insulin infusion rate (U/hour)	Time to target range (from peak insulin infusion rate)	Duration of insulin infusion	Hypoglycemia	Outcome
Naghmi and Kaboor[4], 1988	70/F	DKA	> 1000	< 250	200	9 hours1	NA	Yes	NA
	40/M	DKA	> 600	< 250	400	5 hours1	NA	Yes	NA
	40/M	DKA	> 500	< 250	1000	6 hours1	NA	Yes	NA
	20/M	DKA	> 600	< 250	200	9 hours1	NA	No	NA
Yokoyama et al[5], 1992	65/M	DKA	1241	< 300	10000	6 hours1	23 hours	Yes	Survived
Surani et al[8], 2012	62/F	Septic shock	> 400	< 200	832	5 hours	17 hours	No	NA
Oo et al[9], 2013	60/M	DKA and AMI	847	NA	120	NA	NA	NA	Survived
Illuri et al[6], 2016	64/F	Sepsis	430	180-200	142	16 hours	6 days	No	Deceased
July et al[10], 2017	68/M	AMI, cardiac arrest	434	140-180	280	24 hours1	5 days	No	Deceased
The present case	68/F	Cardiac arrest, sepsis	850	150-200	960	8 hours	11 days	Yes	Deceased

¹Obtained from figures or tables of the reference article.

AMI: Acute myocardial infarction; DKA: Diabetic ketoacidosis; F: Female; M: Male; NA: Not available.