Association of Type B Insulin Resistance and Type 1 Diabetes Resulting in Ketoacidosis

Type B insulin resistance (IR) is a rare autoimmune disease characterized by the presence of autoantibodies directed against the insulin receptor, resulting in a marked IR inducing hyperglycemia (1,2). We describe here what we believe to be a case of type 1 diabetes and ketoacidosis associated with type B IR syndrome.A 55-year-old Caucasian European man with mild obesity (BMI 32.4 kg/m2) was diagnosed as having type 2 diabetes. Insulin therapy was introduced after 3 years of oral antidiabetic therapy when weight loss suggested lack of insulin secretion. Four years after diagnosis, he developed a severe metabolic ketoacidosis. Continuous insulin infusion was promptly introduced, but ketones disappeared only after 6 days. Insulin requirement was exceptionally high (up to 5 units/kg/day …