Insulinopenic diabetes after rodenticide (Vacor) ingestion: a unique model of acquired diabetes in man

Diabetes. 1980 Dec;29(12):971-8. doi: 10.2337/diab.29.12.971.


A clinical syndrome, characterized by acute diabetic ketoacidosis associated with a toxic neuropathy, developed in five men who intentionally ingested a recently introduced rodenticide (Vacor) containing N-3-pyridylmethyl-N'-p-nitrophenyl urea (RH-787). A 7-yr-old boy, who accidentally ingested this poison, died within 14 h. Marked insulinopenia, without a reduction in glucagon levels, suggested a specific beta-cytotoxic effect, which was supported after autopsy in three cases by histopathologic evidence of extensive beta cell destruction. Lethal effects in rats prevented investigation of RH-787's diabetogenicity in vivo; however, studies in isolated rat islets confirmed a direct inhibitory effect, which was prevented by concomitant incubation with nicotinamide, suggesting a mechanism of action similar to that of streptozotocin. We detected islet cell-surface antibodies in two of four patients studied. These findings indicate that this nongenetic, acquired form of insulinopenic diabetes, which has persisted in the surviving patients for up to 3 yr, presents a unique opportunity to test in man the concept that hyperglycemia and the accompanying metabolic consequences of insulinopenia can induced diabetic microangiopathy in the absence of genetic predisposition.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Arginine
  • Blood Glucose / metabolism
  • C-Peptide / blood
  • Child
  • Diabetes Mellitus / chemically induced*
  • Diabetic Ketoacidosis / chemically induced
  • Diabetic Neuropathies / chemically induced
  • Glucagon / blood
  • Glucose Tolerance Test
  • Humans
  • Insulin / blood*
  • Islets of Langerhans / drug effects
  • Male
  • Phenylurea Compounds* / pharmacology
  • Tolbutamide


  • Blood Glucose
  • C-Peptide
  • Insulin
  • Phenylurea Compounds
  • Glucagon
  • Arginine
  • Tolbutamide
  • pyriminil