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September 1974

Insulin-Resistant Diabetic Coma: Acute Onset in an Unknown Diabetic Associated With Brain-Stem Infarction and Death

Author Affiliations

From the Department of Medicine, Harvard Medical School, the Peter Bent Brigham Hospital (Dr. Siegel and Bell), and the E. P. Joslin Research Laboratory (Dr. Steinke), Boston. Dr. Steinke is now with Rancho Los Amigos Hospital, Downey, Calif. Dr. Bell is now with the Johns Hopkins University School of Medicine Hospital, Baltimore. Dr. Bell is the Hubert E. and Anne E. Rogers Scholar in Academic Medicine.

Arch Intern Med. 1974;134(3):562-564. doi:10.1001/archinte.1974.00320210172028

Diabetic ketoacidosis may be the first manifestation of diabetes, particularly in the young patient. In most instances, a careful history will disclose the presence of diabetic symptoms for several days or months. Whereas a relative resistance to insulin is a well-recognized feature of diabetic acidosis, such resistance is usually of moderate intensity and only transient.

We report an unusual case of diabetic ketoacidosis because it occurred in a previously unknown diabetic with documented absence of glycosuria on the preceding day that required 9,200 units of insulin to achieve metabolic control. Most important, it was associated with a fatal brain-stem infarction.

Patient Summary  A 26-year-old, gravida 2, para 0, married woman was admitted for threatened abortion. Review of systems did not suggest any evidence of diabetes. Repeated urine testing for sugar was negative. There was no family history of diabetes mellitus. Physical examination was unremarkable except for scant bleeding through a

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