Spontaneous Hypoglycemia due to Insulin Antibody after Insulin Treatment of Diabetic Ketoacidosis

Abstract

Hypoglycemia in diabetic patients is usually caused by excessive exogenous insulin or the administration of an insulin secretagogue relative to the prevailing glucose concentration. Thus, the clinical manifestations of hypoglycemia are usually not observed in diabetic patients after either insulin or an oral hypoglycemic agent is discontinued. In contrast, diabetic ketoacidosis results from relative or absolute insulin deficiency. Although about 40% of diabetic patients who inject human insulin have insulin antibodies, these antibodies seldom significantly affect the glycemic control. It has not been reported in the literature that insulin antibody in the setting of human insulin therapy is associated with diabetic ketoacidosis and subsequent hypoglycemia. We describe here a rare case of spontaneous hypoglycemia due to insulin antibody after the improvement of diabetic ketoacidosis in a patient with type 2 diabetes mellitus and who had been treated with human insulin. (Endocrinol Metab 25:217-220, 2010)

Insulin Glulisine May Cause a Disease Resembling Insulin Autoimmune Syndrome: Case Report

“…Insulin analogs have an amino acid sequence that differs from that of human insulin, so they are believed to be recognizable as non–self-antigens. Moreover, insulin aggregation mediated by zinc may affect immunogenic potential owing to the longer residence of aggregates at the injection site and easy uptake by antigen-presenting cells ( 4 ). Because glulisine exists as monomers or dimers in solution without zinc, and can be rapidly absorbed into the bloodstream after subcutaneous injection, it is considered to be less immunogenic than other insulin products ( 5 ).…”