Case 10-2024: A 46-Year-Old Woman with Hyperglycemia Refractory to Insulin Therapy

This case report describes a 46 year old woman with hyperglycemia refractory to high dose insulin therapy, initially misdiagnosed as type 2 diabetes. Despite progressive weight loss and escalating insulin doses, her glycemic control worsened. Clinical findings included acanthosis nigricans, acromegaly like features, and undetectable leptin levels. Imaging revealed near complete absence of visceral and subcutaneous fat. Laboratory testing confirmed insulin receptor antibodies, leading to a diagnosis of type B insulin resistance syndrome, a rare autoimmune disorder. The report discusses the differential diagnosis, pathophysiology, and management challenges, including immunosuppressive therapy. The patient’s case highlights the importance of considering atypical causes of insulin resistance in patients with refractory hyperglycemia.

This case report describes a 46 year old woman with hyperglycemia refractory to high dose insulin therapy, initially misdiagnosed as type 2 diabetes. Despite progressive weight loss and escalating insulin doses, her glycemic control worsened. Clinical findings included acanthosis nigricans, acromegaly like features, and undetectable leptin levels. Imaging revealed near complete absence of visceral and subcutaneous fat. Laboratory testing confirmed insulin receptor antibodies, leading to a diagnosis of type B insulin resistance syndrome, a rare autoimmune disorder. The report discusses the differential diagnosis, pathophysiology, and management challenges, including immunosuppressive therapy. The patient’s case highlights the importance of considering atypical causes of insulin resistance in patients with refractory hyperglycemia.