Acute Liver Dysfunction Complicated with Uncontrollable Glycemia due to Insulin Antibody: Successful Treatment with Glucocorticoid and Lispro Insulin

Honda, Munehiro; Kawashima, Yumi; Kawamura, Hiroko; Fujikawa, Hirotoshi; Kikuchi, Kentaro; Ôhashi, Hiroshi; Mori, Yusaku; Miyakawa, Hiroshi; Ishibashi, Masayoshi

doi:10.2169/internalmedicine.45.6009

Cited by 14 publications

(18 citation statements)

References 17 publications

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“…A few previous reports have suggested that corticosteroid therapy has favorable effects on the insulin antibody-induced insulin resistance (4,12). As expected, both eosinophilia and insulin resistance were ameliorated after the treatment with prednisolone.…”

Section: Discussionsupporting

confidence: 79%

“…As expected, both eosinophilia and insulin resistance were ameliorated after the treatment with prednisolone. Corticosteroid therapy was previously reported to modify the characteristics of insulin antibodies, especially in the binding capacity (12). In contrast, the characteristics of insulin antibodies were not strongly affected by prednisolone in the present case; the binding capacity remained high (b1=10.0×10 -8 M) even after the treatment.…”

Section: Discussioncontrasting

confidence: 70%

See 1 more Smart Citation

Severe Insulin-resistant Diabetes due to Insulin Antibodies Associated with Eosinophilia

et al. 2015

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A 66-year-old man with type 2 diabetes on hemodialysis treatment was admitted due to poor glycemic control. His serum insulin level and the 125 I-insulin binding rate were extremely high with an increased eosinophil count, although he did not have an allergic reaction to insulin or an elevation of specific IgE for human insulin. A Scatchard analysis revealed that the patient's insulin antibodies had a low affinity constant and a high binding capacity. Prednisolone administration decreased the eosinophil count and 125 I-insulin binding rate; accordingly, the glycemic control improved. Corticosteroid therapy may be a potent therapeutic strategy for insulin antibody-induced severe insulin resistance with eosinophilia.

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Section: Discussionsupporting

confidence: 79%

Section: Discussioncontrasting

confidence: 70%

Severe Insulin-resistant Diabetes due to Insulin Antibodies Associated with Eosinophilia

et al. 2015

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“…Instability has been described only in case reports and is characterized either by both hyperglycemia and hypoglycemia occurring within a single 24-h interval or by periods lasting days to weeks of hyperglycemia alternating with periods of hypoglycemia of similar duration (49, 176,178,223,229,239,290,291,341,342). Some of these case reports describe patients with relative overnight hypoglycemia and daytime hyperglycemia, although there is no clear mechanistic explanation for such diurnal patterns (see Section V.B.3.c).…”

Section: G Buffering Effect Of Insulin Antibodiesmentioning

confidence: 99%

Immunological Responses to Exogenous Insulin

et al. 2007

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Regardless of purity and origin, therapeutic insulins continue to be immunogenic in humans. However, severe immunological complications occur rarely, and less severe events affect a small minority of patients. Insulin autoantibodies (IAAs) may be detectable in insulin-naive individuals who have a high likelihood of developing type 1 diabetes or in patients who have had viral disorders, have been treated with various drugs, or have autoimmune disorders or paraneoplastic syndromes. This suggests that under certain circumstances, immune tolerance to insulin can be overcome. Factors that can lead to more or less susceptibility to humoral responses to exogenous insulin include the recipient's immune response genes, age, the presence of sufficient circulating autologous insulin, and the site of insulin delivery. Little proof exists, however, that the development of insulin antibodies (IAs) to exogenous insulin therapy affects integrated glucose control, insulin dose requirements, and incidence of hypoglycemia, or contributes to beta-cell failure or to long-term complications of diabetes. Studies in which pregnant women with diabetes were monitored for glycemic control argue against a connection between IAs and fetal risk. Although studies have shown increased levels of immune complexes in patients with diabetic microangiopathic complications, these immune complexes often do not contain insulin or IAs, and insulin administration does not contribute to their formation. The majority of studies have shown no relationship between IAs and diabetic angiopathic complications, including nephropathy, retinopathy, and neuropathy. With the advent of novel insulin formulations and delivery systems, such as insulin pumps and inhaled insulin, examination of these issues is increasingly relevant.

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“…In previous case reports, changing the short-acting insulin from human insulin to insulin lispro help prevent the occurrence of insulin autoimmune hypoglycemia [9,15]. There is no data regarding insulin aspart and occurrence of autoimmune hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

Insulin Autoantibody-Related Hypoglycemic Coma in a Pregnant Woman with Type 1 Diabetes Mellitus

Lü¹,

Wang²,

Peng³

et al. 2017

MOJCR

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Acute Liver Dysfunction Complicated with Uncontrollable Glycemia due to Insulin Antibody: Successful Treatment with Glucocorticoid and Lispro Insulin

Cited by 14 publications

References 17 publications

Severe Insulin-resistant Diabetes due to Insulin Antibodies Associated with Eosinophilia

Severe Insulin-resistant Diabetes due to Insulin Antibodies Associated with Eosinophilia

Immunological Responses to Exogenous Insulin

Insulin Autoantibody-Related Hypoglycemic Coma in a Pregnant Woman with Type 1 Diabetes Mellitus

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