title: Frequent reoccurrence of hypoglycemia in a type 2 diabetic patient with insulin antibodies.
abstract: 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.
authors.affiliation: Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China. hjh560205@263.net
authors.forename: Tie-Yun
authors.initials: TY
authors.lastname: Zhao
authors.forename: Fang
authors.initials: F
authors.lastname: Li
authors.forename: Zhong-Yun
authors.initials: ZY
authors.lastname: Xiong
mesh_terms: 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
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D007330:Insulin Antibodies; D011994:Recombinant Proteins; D008687:Metformin; D005947:Glucose; D020909:Acarbose
references.citation: Diabetes Res Clin Pract. 2003 Aug;61(2):89-92
references.pmid: 12951276
references.citation: Diabetes Care. 2005 Sep;28(9):2161-9
references.pmid: 16123484
references.citation: Proc Assoc Am Physicians. 1999 Jan-Feb;111(1):92-6
references.pmid: 9893161
references.citation: Endocrine. 1997 Jun;6(3):285-91
references.pmid: 9368685
references.citation: Diabet Med. 2009 Jan;26(1):79-82
references.pmid: 19125765
references.citation: Intern Med. 2007;46(17):1321-2
references.pmid: 17827827
references.citation: Metabolism. 1986 Jul;35(7):649-56
references.pmid: 3523119
references.citation: Forensic Sci Int. 2004 Dec 16;146(2-3):105-10
references.pmid: 15542270
references.citation: Acta Diabetol. 2008 Sep;45(3):191-4
references.pmid: 18493700
references.citation: Eur J Clin Invest. 1992 Dec;22(12):772-6
references.pmid: 1478247
references.citation: Ann Med Interne (Paris). 1999 Apr;150(3):245-53
references.pmid: 10445096
references.citation: Diabetes Res Clin Pract. 2009 May;84(2):e21-3
references.pmid: 19328577
references.citation: Diabetes Care. 2009 Jul;32(7):1153-7
references.pmid: 19564471
references.citation: Diabetologia. 1984 Dec;27(6):592-5
references.pmid: 6397385
references.citation: Scand J Clin Lab Invest. 1990 Sep;50(5):551-7
references.pmid: 2237267
references.citation: Dtsch Med Wochenschr. 1990 Dec 21;115(51-52):1950-5
references.pmid: 2261860
references.citation: Diabetes Res Clin Pract. 2006 Jun;72(3):238-43
references.pmid: 16439034
references.citation: Endocr Rev. 2007 Oct;28(6):625-52
references.pmid: 17785428
references.citation: Nat Clin Pract Endocrinol Metab. 2007 Dec;3(12):835-40
references.pmid: 18026162
references.citation: Diabetologia. 1985 Jun;28(6):330-4
references.pmid: 3899818
references.citation: Lupus. 2009 Apr;18(5):457-9
references.pmid: 19318401
references.citation: Tohoku J Exp Med. 1997 Jun;182(2):163-73
references.pmid: 9261935
references.citation: Acta Diabetol. 2010 Jun;47(2):131-5
references.pmid: 19547910