THE INFLUENCE OF OVARIAN ACTIVITY AND ADMINISTERED ESTROGENS UPON DIABETES MELLITUS: CASE REPORT

Abstract

Diabetes discovered at the age of 12 yrs. in a 31 yr. old 9 was easily controlled until the onset of menstruation at the age of 18. In the intervening 13 yrs. since catamenia was established, the patient has been repeatedly treated for shock and coma, respectively, despite the fact that she has made a reasonable effort to follow prescribed regimes. Analysis of her previous history and hospitalizations, and observation over a continuous period of nearly 2 yrs. clearly demonstrate that a decrease in glucose tolerance occurred with every menstrual flow and an increase in the same between the 8th and 20th days of her 26-30 day cycle. The degree of variation in tolerance is illustrated by the fact that 70-80 units of insulin were necessary for control at the time of flow, whereas 35 units would suffice to maintain a "sugarfrce" urine at "mid-interval." By the use of estradiol dipropionate injns. (1-5 mg. doses at 2-5 day intervals) in the latter half of each cycle, it was possible to decrease the dose of insulin to 25 units daily without the appearance of acidosis during the menstrual flow and without the development of shock during the ovulatory, and pre- and post-ovulatory phases of the cycle. The relationship of these findings to the activity of the ovary, pituitary, and the pancreas is discussed. As far as we know she represents the first recorded instance of a diabetic subject, whose normal cyclic gonadal activity alternately produced hypo-glycemic shock and acidosis. These complications of treatment were prevented by (a) varying the dose of insulin at different points in the menstrual cycle; (b) adjusting the intake of food in relation to menstruation and (c) the administering estrogens between the 20th day of the cycle and the onset of flow.