Severe insulin resistance due to anti-insulin antibodies: response to plasma exchange and immunosuppressive therapy.

Abstract

Anti-insulin antibodies have been described in two contexts: in insulin-naive individuals (so-called 'insulin autoimmune syndrome') and in patients with insulin-treated diabetes, in whom antibodies are rarely of clinical significance. We report the case of an 68-year-old woman who exhibited a local allergic reaction to subcutaneous insulin followed by severe insulin resistance, evidenced by poor glycaemic control despite treatment with > 3.5 U/kg of insulin per day. She was found to have circulating polyclonal anti-insulin antibodies of the IgG subtype and responded clinically to a course of plasma exchange and immunosuppression with mycophenolate mofetil and, subsequently, intravenous immunoglobulin. Falling titres of antibodies on this regimen correlated with improved glycaemic control. This case suggests that clinicians should be alert to the possibility of insulin resistance due to anti-insulin antibodies and that immunosuppression in this situation may be a valuable therapeutic option.

• Authors: J R Greenfield, A Tuthill, M A Soos, R K Semple, D J Halsall, A Chaudhry, S O'Rahilly
• Journal: Diabetic medicine : a journal of the British Diabetic Association (Diabet Med) Vol. 26 Issue 1 Pg. 79-82 (Jan 2009) ISSN: 1464-5491 [Electronic] England
• PMID: 19125765 (Publication Type: Case Reports, Journal Article)

Chemical References

• Immunosuppressive Agents
• Insulin
• Insulin Antibodies
• Mycophenolic Acid

Topics

• Aged
• Antigen-Antibody Reactions (immunology)
• Diabetes Mellitus, Type 2 (blood, drug therapy, immunology)
• Female
• Humans
• Immunosuppressive Agents (therapeutic use)
• Injections, Subcutaneous (methods)
• Insulin (blood, immunology)
• Insulin Antibodies (blood, immunology)
• Insulin Resistance (immunology)
• Mycophenolic Acid (analogs & derivatives, therapeutic use)
• Plasma Exchange (methods)