Insulin Antibody-induced Diabetic Ketoacidosis in an Elderly Type 2 Diabetic Ameliorated with Prednisolone

In the patients who are treated with insulin, the synthesis of insulin antibodies occasionally induce difficulty in glycaemic management. Insulin antibodies are now being closely examined in the context of diabetes treatment. Although, human insulin analogues are supposed to be less antigenic; however, insulin antibodies may mimic severe insulin resistance or blood glucose brittleness in some cases. We hereby report the case of an 82-year-old male with insulin-treated Type 2 diabetes admitted to our hospital and diagnosed with diabetic ketoacidosis and acute pancreatitis. His levels of insulin antibodies and binding rate was very high. Intravenous insulin infusion and gabexate mesilate were administered. The acute pancreatitis improved but ketoacidosis re-emerged during insulin infusion. After administration of 30 mg prednisolone, infusion with insulin detemir was discontinued. On the day of discharge, his glycaemic control was good and the patient was prescribed low dose prednisolone, 8 U/day of insulin detemir, and 150 mg of miglitol. Therefore, severe immuno-insulin resistance can cause diabetic ketoacidosis and steroid might be an useful therapeutic target for insulin antibody-induced diabetic ketoacidosis.