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Five patients with steroid-induced diabetic ketosis are described. The severity of ketosis has not been described in this condition previously. Of the 13 patients previously reported, only 2 were moderately ketotic. Four of our patients had SLE and all were on high-dose steroids for several months. All responded promptly to treatment. The relative rarity of ketosis in steroid diabetes may be related to the gluconeogenic and glycogenic effects of steroids. Those who develop ketosis presumably have reached a critical level of steroid effect at which its antagonism to insulin ultimately leads to ketosis. One patient developed insulin resistance during the course of treatment with steroids and nitrogen mustard. Insulin resistance occurred as a result of the development of insulin antibodies. Insulin resistance disappeared spontaneously.

(C) Copyright 1971 Southern Society for Clinical Investigation