Since July 1935 my colleagues and I have had the opportunity of observing a diabetic patient with crippling although afebrile rheumatoid arthritis who has required from 240 to 675 units of insulin daily for control of hyperglycemia and glycosuria. The situation is so extraordinary that certain special studies have been made which are reported in the present communication. Although one sees patients occasionally who require large quantities of insulin, almost invariably a responsible complication can be disclosed, and, even so, the total daily dose rarely exceeds 100 units. The case to be described is without parallel in a group of approximately 11,500 patients with true diabetes seen in this clinic since the introduction of insulin in 1922. The only other patient in our series with an enormous insulin requirement was a doctor with hemochromatosis, previously reported on,1 who died in coma despite a final dosage of 1,680 units of
MARBLE A. INSULIN RESISTANCE: REPORT OF A CASE OF MARKED INSENSITIVENESS OF LONG DURATION WITHOUT DEMONSTRABLE CAUSE. Arch Intern Med (Chic). 1938;62(3):432–446. doi:https://doi.org/10.1001/archinte.1938.00180140079007
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