Frequent reoccurrence of hypoglycemia in a type 2 diabetic patient with insulin antibodies.
BACKGROUND
Insulin antibody (IAb) may be produced in patients receiving long-term, animal-derived insulin, leading to insulin resistance or hypoglycemia. There have been very few reports of hypoglycemia caused by IAb in patients taking recombinant human insulin.


METHODS
We report the case of an 82-year-old male patient with type 2 diabetes mellitus who suffered repeated episodes of severe hypoglycemia-related symptoms (including coma) prior to admission. The patient had been taking Novolin 30R, a premixed human insulin. The patient's IAb level was markedly elevated, and hypoglycemia caused by recombinant human insulin treatment-induced IAb production was diagnosed. Acarbose and metformin were prescribed, and the patient recovered uneventfully. The patient ceased taking these medications, and he was subsequently treated with recombinant human insulin to combat hyperglycemia. This was followed by reoccurrence of hypoglycemic coma. The patient was advised to avoid taking recombinant human insulin for the rest of his life and to control hyperglycemia with acarbose and metformin.


CONCLUSIONS
Although rare, hypoglycemia caused by recombinant human insulin-induced IAb production should be considered in patients with type 2 diabetes who experience repeated episodes of hypoglycemia.
Zhao
Tie-Yun
TY
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China. hjh560205@263.net
Li
Fang
F
Xiong
Zhong-Yun
ZY
D020909:Acarbose / Q000627:therapeutic use; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000276:immunology*; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology*; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects* / Q000097:blood / Q000276:immunology / Q000627:therapeutic use; D007330:Insulin Antibodies / Q000097:blood*; D007331:Insulin Coma / Q000188:drug therapy / Q000276:immunology; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000009:adverse effects / Q000276:immunology
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D007330:Insulin Antibodies; D011994:Recombinant Proteins; D008687:Metformin; D005947:Glucose; D020909:Acarbose
Diabetes Res Clin Pract. 2003 Aug;61(2):89-92
12951276
Diabetes Care. 2005 Sep;28(9):2161-9
16123484
Proc Assoc Am Physicians. 1999 Jan-Feb;111(1):92-6
9893161
Endocrine. 1997 Jun;6(3):285-91
9368685
Diabet Med. 2009 Jan;26(1):79-82
19125765
Intern Med. 2007;46(17):1321-2
17827827
Metabolism. 1986 Jul;35(7):649-56
3523119
Forensic Sci Int. 2004 Dec 16;146(2-3):105-10
15542270
Acta Diabetol. 2008 Sep;45(3):191-4
18493700
Eur J Clin Invest. 1992 Dec;22(12):772-6
1478247
Ann Med Interne (Paris). 1999 Apr;150(3):245-53
10445096
Diabetes Res Clin Pract. 2009 May;84(2):e21-3
19328577
Diabetes Care. 2009 Jul;32(7):1153-7
19564471
Diabetologia. 1984 Dec;27(6):592-5
6397385
Scand J Clin Lab Invest. 1990 Sep;50(5):551-7
2237267
Dtsch Med Wochenschr. 1990 Dec 21;115(51-52):1950-5
2261860
Diabetes Res Clin Pract. 2006 Jun;72(3):238-43
16439034
Endocr Rev. 2007 Oct;28(6):625-52
17785428
Nat Clin Pract Endocrinol Metab. 2007 Dec;3(12):835-40
18026162
Diabetologia. 1985 Jun;28(6):330-4
3899818
Lupus. 2009 Apr;18(5):457-9
19318401
Tohoku J Exp Med. 1997 Jun;182(2):163-73
9261935
Acta Diabetol. 2010 Jun;47(2):131-5
19547910