Endocrine Abstracts

Introduction: Insulin resistance is one of the characteristic abnormalities of type 2 diabetes. Recently it has been recognized that type 1 diabetes may also present with insulin resistance of varying intensity. We report a case of insulin resistance in a patient with type 1 diabetes.

Observation: The patient was 23 years old, with a history of type 1 diabetes since the age of 20, with positive antibodies against GAD (glutamate acid decarboxylase), revealed by a cardinal syndrome with inaugural ketosis on discovery under high dose insulin: mixtar30 (70IU at 08:00 - 30IU at 12:00 - 64IU at 20:00) and Actrapid: (5IU at 08:00 - 38IU at 12:00 - 34IU at 20:00), no diabetic heredity. The admission examination revealed a stable conscious patient with hyperglycemia between 2.53 and 3.23 g/l, systolic pressure at 132 mmhg, body mass index (BMI) at 22 kg/m² with a waist circumference (WC) of 77 cm. Biology showed normal transaminases: ALT 38U/l, ASAT 33U/l, GGT 12UI/l, total cholesterol 1.67 g/l, LDL 1.28 g/l, HDL 0.61g/l, Triglycerides 1.36 g/l, management consisted of the introduction of oral antidiabetic drugs: metformin 2 g, empagliflozin 10 mg/d, in combination with insulin. The evolution was marked by the improvement of the glycemic figures with reduction of the doses of insulin, currently under: mixtard30: (24UI at 08 h-00-24UI at 20 h) metformine 2g/d and jardiance 10 mg/d.

Discussion: Insulin resistance is mainly related to type 2 diabetes. Recently it has been recognized that type 1 diabetes may also present insulin resistance of variable intensity. The pathophysiology of this insulin resistance is not known. Hypotheses have been put forward, notably a deficit in muscle oxidative phosphorylation. In our case, the high doses of insulin and the chronic imbalance despite the respect of the injections and the dietary rules pushed us to evoke insulin resistance. The improvement of the glycemic figures after the setting on ADO in particular metformin and the recourse to lesser doses of insulin reinforced our diagnosis. Insulin resistance remains rare in type 1 diabetics and the pathophysiological mechanisms have not yet been elucidated, but it should be considered when faced with profiles of type 1 diabetics who remain in chronic imbalance under very high doses of insulin.