Plasmapheresis in Intractable Insulin-Resistant Diabetes

A Woman with Diabetes Mellitus Complicated by Insulin Antibody Interactions

“…1,3,4,6 Due to the severity of fl uctuating glucose levels, a trial of therapeutic plasmapheresis was initiated with the goal of achieving improved glycemic control. In addition, after testing normal for TMPT enzyme activity, treatment with azathioprine 50 mg daily was initiated with the goal of augmenting the decreased production of antibodies to insulin.…”

Brittle diabetes: Strategies, diagnosis, and treatment

“…These range from the insertion and reinsertion of Hickman catheters for intravenous insulin delivery69 to plasmaphoresis to remove an unknown brittle dia-betes-inducing substance. 70 In our experience, invasive procedures are frequently misused and result in unacceptable patient morbidity. These procedures are usually employed in patients in whom an etiology for the brittle diabetes has not been identified (usually because of inadequate clinical testing).…”