[Hyperglycemic hyperosmolar non-ketotic diabetic coma with prolonged insulin-resistnace and extremely high values of insulin-IgG-binding]. / Coma diabetico iperglicemico iperosmolare non-chetosico con relativa insulinoresistenza protratta e valori estremamente elevati di insulin-IgG-binding

The paper reports the occurrence - over a period of some days - of a hyperosmolar non ketotic coma, with prolonged relative insulin-resistnace in a micro- and macroangiopathic long term diabetic subject, after infection and minor surgery. The patient was on oral hypoglycemic treatment during the past 11 years; previously he had been treated with Protamin Zinc Insulin. The case is characterized by extremely high values of Insulin-IgG-binding (12 MU/ml), which still further increased to 20 mU/ml when an emergency insulin management was recommenced, perhaps as the result of an immunogenic booster effect. A diagram of underlying and precipitating conditions likely to lead to diabetic non-ketotic coma is presented. Exogenous anti-insulin immunitary factors are postulated as exceptional condidates for inclusion.