title: A Male with Extreme Subcutaneous Insulin Resistance: A Case Report.
abstract: BACKGROUND
  Though insulin has no upper limit in dosage, we do not encounter very high dose requirements too often. The reported case is the first in Bangladesh to require more than 1000 international units (IU) of subcutaneous insulin per day.
  
  
  METHODS
  A 44-year old male diabetic patient from Bangladesh presented with unusually uncontrolled diabetes mellitus due to extreme insulin resistance. Despite dramatic increase in insulin step by step up to 1110 IU of concomitant short and intermediate acting insulin per day by subcutaneous route, his blood glucose remained over 12 mmol/L persistently, in all the fasting, pre-prandial, postprandial and random samples. He was also treated with several oral hypoglycemic agents including metformin, vildagliptin, glimepiride, pioglitazone and miglitol along with insulin but blood glucose levels remained almost unchanged. However, intravenous infusion of insulin over 4 hours caused a plummet in the glucose level. His blood test for insulin autoantibody was negative.
  
  
  CONCLUSIONS
  This paper provides a scope to review literatures on extreme subcutaneous insulin resistance and its management. It also reveals the limitations of management due to lack of facilities in an underdeveloped country, which hinders proper exploration to many medical issues.
authors.affiliation: Department of Endocrinology, Dhaka Medical College Hospital, Dhaka, Bangladesh.
authors.forename: Zuhayer
authors.initials: Z
authors.lastname: Ahmed
authors.affiliation: Department of Endocrinology, Dhaka Medical College Hospital, Dhaka, Bangladesh.
authors.forename: Indrajit
authors.initials: I
authors.lastname: Prasad
authors.affiliation: Department of Endocrinology, Dhaka Medical College Hospital, Dhaka, Bangladesh.
authors.forename: Hafizur
authors.initials: H
authors.lastname: Rahman
authors.affiliation: Department of Endocrinology, Dhaka Medical College Hospital, Dhaka, Bangladesh.
authors.forename: Jalil
authors.initials: J
authors.lastname: Ansari
authors.affiliation: Department of Endocrinology, Dhaka Medical College Hospital, Dhaka, Bangladesh.
authors.forename: Khaled
authors.initials: K
authors.lastname: Hassan
keywords: Diabetes Mellitus; Insulin Resistance; Subcutaneous Injection