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Severe insulin resistance secondary to insulin antibodies: successful treatment with the immunosuppressant MMF.

Abstract
We have evaluated the use of the immunosuppressant mycophenolate mofetil (MMF) in the treatment of severe insulin resistance caused by neutralising anti-insulin antibodies in type 1 diabetes mellitus (T1DM). A 12-yr-old boy with a 5-month history of T1DM developed severe immunological insulin resistance secondary to human insulin antibodies. Various different treatment modalities, including lispro insulin, intravenous insulin, prednisolone and immunoabsorption, were tried, all without a sustained response to treatment. Although the introduction of the immunosuppressant MMF only resulted in a small reduction in haemoglobin A1c (from 10.9 to 9.8%), it did result in a significant reduction in insulin requirements from 6000 to 250 U/d (75 to 3.1 U/kg/d), disappearance of the severe nocturnal hypoglycaemia associated with high titres of insulin antibodies and a reduction in the level of these antibodies from 34.6 to 2.7 mg/dL. MMF may be considered as a means of immunosuppression in patients with markedly raised insulin antibodies whose diabetes cannot be controlled with insulin alone.
AuthorsT Segal, Ea Webb, R Viner, C Pusey, G Wild, J Allgrove
JournalPediatric diabetes (Pediatr Diabetes) Vol. 9 Issue 3 Pt 1 Pg. 250-4 (Jun 2008) ISSN: 1399-5448 [Electronic] Denmark
PMID18547238 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Immunosuppressive Agents
  • Insulin
  • Insulin Antibodies
  • Prednisolone
  • Mycophenolic Acid
Topics
  • Blood Glucose (metabolism)
  • Child
  • Diabetes Mellitus, Type 1 (blood, drug therapy, immunology)
  • Glycated Hemoglobin (analysis)
  • Humans
  • Hypoglycemic Agents (therapeutic use)
  • Immunosuppressive Agents (therapeutic use)
  • Insulin (blood, therapeutic use)
  • Insulin Antibodies (blood)
  • Insulin Resistance (immunology)
  • Male
  • Mycophenolic Acid (analogs & derivatives, therapeutic use)
  • Prednisolone (therapeutic use)

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