Abstract
Some diabetics in the Tropics are young undernourished and ketosis resistant at presentation yet require high doses of insulin for control from onset suggesting insulin resistance. They usually have histories suggestive of past childhood malnutrition. WHO categorized them as malnutrition-related diabetes mellitus (MRDM) taking into account the preceding and presenting protein energy malnutrition (PEM). PEM has been reported to cause insulin deficiency and glucose intolerance as well as insulin resistance. However the PEM preceding the onset of diabetes is hardly ever documented in such cases and hence is open to question. PEM at presentation with diabetes which is frequently documented can result to some extent from uncontrolled hyperglycaemia and hence is also found in Type 1 and Type 2 diabetics. Thus the identification of young insulin requiring ketosis resistant diabetics as MRDM is difficult and sometimes doubted. In this context we are reporting three diabetic children =5 years old who in addition to strong ketosis resistance and high insulin requirement had documented PEM which preceded and was unrelated to diabetes. (excerpt)
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