At presentation, he gave a past medical history of intermittent ulcerative colitis diagnosed in 1992,which was then under good control, and of appendicectomy in April 1997. He had required insulin (20–30 units per day) for prednisolone-induced diabetes during treatment for previous exacerbation of colitis. He weighed 105 kg and on examination was a very fit man. He had no diabetic complications(specifically no evidence of peripheral vascular disease) and normal peripheral sensation, power, tone and reflexes. The random blood glucose was 25 mmol/l associated with moderate ketonuria, but no proteinuria. The results of investigation suggested
a diagnosis of type 2 diabetes with a negative islet cell antibody titre and detectable C-peptide.