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In Reply.—We agree with the comments of Drs Dorchy and Loeb that there is almost total absence of pancreatic insulin reserves in nonketotic hyperosmolar diabetes mellitus. In the case we reported, as well as in another similar case seen recently of a 16-year-old boy at the onset of diabetes mellitus, we were unable to demonstrate immunoreactive insulin concentrations in excess of 25μU/ml. In our newest patient, the serum insulin level was only 28μU when his blood sugar was 1,610 mg/100 ml.
We would like to thank the authors for the additional eight references that our literature search did not uncover.
GINSBERG-FELLNER F, PRIMACK WA. Recurrent Hyperosmolar Nonketotic Episodes in a Young Diabetic-Reply. Am J Dis Child. 1976;130(7):779-780. doi:10.1001/archpedi.1976.02120080101016