Case of cobalt poisoning.

MEDICLSHORNArequirements of diabetic patients alter with changes in physiological stress without simultaneous alteration in insulin anti- body levels.This does not of course prove that insulin antibodies do not influence the insulin requirements from patient to patient.The studies reported here, showing that the majority of beef-insulin-treated diabetic patients can be maintained on a smaller dose of pork insulin, which can be predetermined by preferential insulin antibody-binding studies, indicate that antibodies to insulin account for a fixed aliquot of the daily insulin requirement.The immediate clinical problem raised by this study is the necessity to exercise caution in changing diabetic patients from a pure beef-insulin preparation to a pure pork-insulin prepara- tion.The theoretical possibility of deliberately inducing bovine-insulin antibodies and subsequently altering to porcine insulin in view of the failure of porcine insulin to produce a primary antibody response under these circumstances (Devlin and Stephenson, 1966) must be considered. SUMMARYThe majority of a beef-insulin-treated diabetic population preferentially bind beef, pork, and human insulins in the order beef>pork>human.The theoretical implications of this observation are briefly discussed.