title: Acute liver dysfunction complicated with uncontrollable glycemia due to insulin antibody: successful treatment with glucocorticoid and lispro insulin.
abstract: Here, we report a case of acute liver dysfunction complicated with uncontrollable glycemia due to insulin antibody. The patient was admitted to our hospital due to diabetic ketoacidosis. He was administered insulin immediately, however, his fasting plasma glucose level remained unstable despite the insulin treatment. Blood biochemistry revealed severe liver dysfunction, although no markers including hepatitis virus or autoantibodies associated with autoimmune liver diseases were detected. The 125I-insulin binding rate was high (54%). The characteristics of insulin antibody in this patient were similar to the antibodies of IAS patients, therefore we administered oral glucocorticoid against insulin antibody. The reduction in the 125I-insulin binding rate and the binding capacity of the high affinity site of insulin antibodies were balanced after oral glucocorticoid therapy. In addition, preprandial subcutaneous regular insulin was switched to lispro insulin. Postprandial plasma glucose levels were relatively improved by lispro insulin. The etiology of acute liver dysfunction was unknown, however, we believe that the combination of oral glucocorticoid and lispro insulin was suitable and useful for preventing recurrent liver dysfunction in this patient.
authors.affiliation: Fourth Department of Medicine, Teikyo University Shool of Medicine, Kawasaki.
authors.forename: Munehiro
authors.initials: M
authors.lastname: Honda
authors.forename: Yumi
authors.initials: Y
authors.lastname: Kawashima
authors.forename: Hiroko
authors.initials: H
authors.lastname: Kawamura
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Fujikawa
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohashi
authors.forename: Yasumichi
authors.initials: Y
authors.lastname: Mori
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyakawa
authors.forename: Miyuki
authors.initials: M
authors.lastname: Ishibashi
mesh_terms: D000208:Acute Disease; D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D007328:Insulin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D007330:Insulin Antibodies / Q000009:adverse effects / Q000097:blood*; D061268:Insulin Lispro; D008107:Liver Diseases / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D008297:Male
chemical_list: D005938:Glucocorticoids; D007328:Insulin; D007330:Insulin Antibodies; D061268:Insulin Lispro