Biochemical and physiological manifestations of acute insulin withdrawal.

When insulin is withdrawn acutely from a severely diabetic patient, a sequence of intricately interconnected events begins which, without intervention, can result in coma and death. These events involve not only carbohydrate metabolism, but protein and lipid metabolism, electrolyte and fluid balance as well. Acute insulin withdrawal permits the unopposed action of the counter-regulatory hormones (which are attempting to elevate the plasma glucose concentration), namely glucagon, cortisol, growth hormone, and epinephrine. This article details interrelationships existing between the many biochemical and physiological events that are occurring more or less simultaneously in the animal following acute insulin withdrawal.