Leblanc H, Jadaud J M, Dejax C, Saltiel H, Passa P
Presse Med. 1984 Apr 14;13(16):987-9.
Insulin resistance is a permanent feature of lipoatrophic diabetes, the resistance being almost regularly stubborn. We report the case of a 23-year old unmarried woman with generalized lipoatrophy and Acanthosis nigricans. Seven years after a diabetes resistant to all treatments was diagnosed, blood glucose levels were permanently around 25 mmol/l. Multiple and severe micro- and macroangiopathies were present. Partial resistance to insulin was demonstrated. This resistance could not be explained by abnormalities in anti-insulin hormones nor by a decrease in the number or affinity of insulin receptors, which suggested an intracellular abnormality below membrane receptors. Sustained control of glycaemia at a normal level was achieved by continuous infusion of insulin in high doses. It would appear that optimum insulin therapy using an insulin pump would offer hopes of therapeutic success in this particular form of insulin resistance.
胰岛素抵抗是脂肪萎缩性糖尿病的一个永久性特征，这种抵抗几乎总是顽固的。我们报告了一例23岁未婚女性，患有全身性脂肪萎缩和黑棘皮病。在诊断出对所有治疗均耐药的糖尿病7年后，血糖水平一直维持在25 mmol/l左右。存在多种严重的微血管和大血管病变。证实存在部分胰岛素抵抗。这种抵抗既不能用抗胰岛素激素异常来解释，也不能用胰岛素受体数量或亲和力降低来解释，这提示膜受体以下存在细胞内异常。通过高剂量持续输注胰岛素实现了血糖在正常水平的持续控制。看来，使用胰岛素泵进行最佳胰岛素治疗有望在这种特殊形式的胰岛素抵抗中取得治疗成功。
