title: Immunological and metabolic responses of patients with history of antibody-induced beef insulin resistance to treatment with beef, pork, human, and sulfated beef insulin.
abstract: OBJECTIVE
  We evaluated immunological and metabolic responses during therapy with beef (B), pork (P), human (H, rDNA), and sulfated beef (SB) insulins in patients with insulin-antibody-mediated insulin resistance.
  
  
  METHODS
  A randomized double-blind sequential crossover study was performed with each insulin administered for 56 days unless dose reached 200 U/day or allergy developed. Participants were 26 individuals with history of B-P insulin dosage greater than or equal to 200 U/day and insulin binding capacities greater than 0.216 nM (30 mU/ml serum). Twenty-one participants completed the study. Insulin dosage/day, fasting plasma glucose, percentage HbA1, insulin antibody binding capacity (IABC), bound insulin (BI), percentage binding of 125I-labeled B, P, and H insulins, and receptor inhibition factor (RIF) were assessed.
  
  
  RESULTS
  Mean insulin dosage (U/day) was significantly greater on B (88.9) than on P (29.2), H (29.4), or SB (29.6). On B, dosage increased in 12 individuals and reached 200 U/day in 6 individuals. Mean fasting plasma glucose (12.1 mM) and HbA1 (11%) were significantly higher on B than on P, H, and SB. Mean IABC, bound insulin, RIF, and percentage of B, P, and H bound were significantly higher on B than on P, H, and SB. Prolonged treatment with SB before entry into the study (greater than 5 wk) resulted in a blunted anamnestic response to B insulin.
  
  
  CONCLUSIONS
  Rechallenge with B results in anamnestic immunological response and deterioration of metabolic control. SB, H, and P insulins have equivalent effects in patients with insulin antibody-mediated immunologic resistance.
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis.
authors.forename: J K
authors.initials: JK
authors.lastname: Davidson
authors.forename: S E
authors.initials: SE
authors.lastname: Fineberg
authors.forename: P
authors.initials: P
authors.lastname: De Meyts
authors.forename: N S
authors.initials: NS
authors.lastname: Fineberg
authors.forename: J A
authors.initials: JA
authors.lastname: Galloway
mesh_terms: D000818:Animals; D001786:Blood Glucose / Q000378:metabolism; D002417:Cattle; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D004311:Double-Blind Method; D006442:Glycated Hemoglobin / Q000032:analysis; D007328:Insulin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use*; D007330:Insulin Antibodies; D007333:Insulin Resistance; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D013552:Swine
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; D007330:Insulin Antibodies; D011994:Recombinant Proteins; C076568:sulfated beef insulin