title: Type B Insulin Resistance in Peru.
abstract: Type B insulin resistance (IR) is a rare autoimmune disease characterized by the presence of insulin receptor autoantibodies, resulting in a marked IR inducing hyperglycemia. Our first case is a 42-year-old female with a history of RA, SLE and Hashimoto-thyroiditis that presented with cachexia, acanthosis-nigricans, hirsutism, negative anti-insulin-ab and glucose level between 400 to 700 mg/dl, despite a total insulin dose of 1000 IU/day. She received pulses of cyclophosphamide along with prednisone. One year later the patient was off insulin and with HbA1c of 5.6%. The second case is a 42-year-old female patient that presented with polyuria, polydipsia, cachexia, acanthosis-nigricans, negative glutamic-acid-decarboxilase-ab and positive TPO-ab. She received IV infusion of regular insulin at a rate of 500 UI/d. Two years later she was off insulin with HbA1C of 5.6%. As summary, we reported a case of a disease remitted after receiving immunosuppressive therapy and a case of disease remitted spontaneously.
authors.affiliation: Internal Medicine Program, Louis A. Weiss Memorial Hospital, Chicago, Illinois; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru. Electronic address: hzeladac@weisshospital.com.
authors.forename: Henry
authors.initials: H
authors.lastname: Zelada
authors.affiliation: Endocrinology Unit, Hospital Nacional Dos de Mayo, Lima, Peru.
authors.forename: Dante
authors.initials: D
authors.lastname: Gamarra
authors.affiliation: Endocrinology Unit, Hospital Nacional Dos de Mayo, Lima, Peru.
authors.forename: Hugo
authors.initials: H
authors.lastname: Arbañil
authors.affiliation: Endocrinology Unit, Hospital Nacional Arzobispo Loayza, Lima, Peru.
authors.forename: Helard
authors.initials: H
authors.lastname: Manrique
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000276:immunology*; D001327:Autoimmune Diseases / Q000188:drug therapy / Q000276:immunology*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007333:Insulin Resistance; D010568:Peru; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D011972:Receptor, Insulin / Q000276:immunology*; D012074:Remission Induction
chemical_list: D001323:Autoantibodies; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011972:Receptor, Insulin; D011241:Prednisone
keywords: Developing country; Immunosuppressive therapy; Insulin resistance; Latin America; Peru