This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pathology
Osmotic damage is operative in all of the following complications of diabetes mellitus EXCEPT 
Select and explain. 
A. The formation of cataracts, B. Insulin receptor deficiency, C. Microaneurysms in retinal vessels, D. Peripheral neuropathy
B: Insulin receptor deficiency
Answer: B: Insulin receptor deficiency 
Explanation: Osmotic damage is inoperative in insulin- receptor deficiency. Insulin-receptor deficiency is the result of an increase in adipose, which down regulates receptor synthesis, and chronic elevation of glucose (glucose toxicity), which renders the receptors less receptive to insulin.