Severe insulin resistance due to anti‐insulin antibodies: response to plasma exchange and immunosuppressive therapy
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...
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| Veröffentlicht in: | Diabetic medicine 2009-01, Vol.26 (1), p.79-82 |
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| creator | Greenfield, J. R. Tuthill, A. Soos, M. A. Semple, R. K. Halsall, D. J. Chaudhry, A. O’Rahilly, S. |
| description | 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. |
| doi_str_mv | 10.1111/j.1464-5491.2008.02621.x |
| format | Article |
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R. ; Tuthill, A. ; Soos, M. A. ; Semple, R. K. ; Halsall, D. J. ; Chaudhry, A. ; O’Rahilly, S.</creator><creatorcontrib>Greenfield, J. R. ; Tuthill, A. ; Soos, M. A. ; Semple, R. K. ; Halsall, D. J. ; Chaudhry, A. ; O’Rahilly, S.</creatorcontrib><description>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.</description><identifier>ISSN: 0742-3071</identifier><identifier>EISSN: 1464-5491</identifier><identifier>DOI: 10.1111/j.1464-5491.2008.02621.x</identifier><identifier>PMID: 19125765</identifier><identifier>CODEN: DIMEEV</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Aged ; Antigen-Antibody Reactions - immunology ; anti‐insulin antibodies ; Biological and medical sciences ; diabetes ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes Mellitus, Type 2 - immunology ; Diabetes. Impaired glucose tolerance ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Feeding. Feeding behavior ; Female ; Fundamental and applied biological sciences. Psychology ; Humans ; Immunosuppressive Agents - therapeutic use ; Injections, Subcutaneous - methods ; Insulin - blood ; Insulin - immunology ; Insulin Antibodies - blood ; Insulin Antibodies - immunology ; insulin resistance ; Insulin Resistance - immunology ; Medical sciences ; mycophenolate ; Mycophenolic Acid - analogs & derivatives ; Mycophenolic Acid - therapeutic use ; plasma exchange ; Plasma Exchange - methods ; Vertebrates: anatomy and physiology, studies on body, several organs or systems ; Vertebrates: endocrinology</subject><ispartof>Diabetic medicine, 2009-01, Vol.26 (1), p.79-82</ispartof><rights>2009 The Authors. 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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.</description><subject>Aged</subject><subject>Antigen-Antibody Reactions - immunology</subject><subject>anti‐insulin antibodies</subject><subject>Biological and medical sciences</subject><subject>diabetes</subject><subject>Diabetes Mellitus, Type 2 - blood</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Diabetes Mellitus, Type 2 - immunology</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Endocrine pancreas. 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Psychology</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Injections, Subcutaneous - methods</subject><subject>Insulin - blood</subject><subject>Insulin - immunology</subject><subject>Insulin Antibodies - blood</subject><subject>Insulin Antibodies - immunology</subject><subject>insulin resistance</subject><subject>Insulin Resistance - immunology</subject><subject>Medical sciences</subject><subject>mycophenolate</subject><subject>Mycophenolic Acid - analogs & derivatives</subject><subject>Mycophenolic Acid - therapeutic use</subject><subject>plasma exchange</subject><subject>Plasma Exchange - methods</subject><subject>Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><subject>Vertebrates: endocrinology</subject><issn>0742-3071</issn><issn>1464-5491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqN0ctu1DAUBmALgehQeAWUDewSfIsdI7FApbSViroA1pbjnFCPcsNn0s7seASekSfB6UzLknpzbPk7tuWfkIzRgqXxbl0wqWReSsMKTmlVUK44K7ZPyOph4ylZUS15LqhmR-QF4ppSxo0wz8kRM4yXWpUrMn-FG4iQhQHnLgxZBAy4cYOHrJkh24yZGzbhz6_f92BZ1mMTAN8veBoHvGNT57B3GWz9tRt-QHJNFvp-HkacpylJDDcJXkN00-4leda6DuHVoR6T759Pv52c55dXZxcnHy9zX0rJct5KV2opdMWcF8Y4raVpVO3bVismgSpX1944U5etqmQjROshdaZaUl5RcUze7s-d4vhzBtzYPqCHrnMDjDNapbTRXLP_Qr58sOAiwWoPfRwRI7R2iqF3cWcZtUs2dm2XCOwSgV2ysXfZ2G1qfX24Y657aP41HsJI4M0BOPSua2OKIeCD44xKpZlK7sPe3YYOdo9-gP305XSZib9nf60t</recordid><startdate>200901</startdate><enddate>200901</enddate><creator>Greenfield, J. R.</creator><creator>Tuthill, A.</creator><creator>Soos, M. A.</creator><creator>Semple, R. K.</creator><creator>Halsall, D. J.</creator><creator>Chaudhry, A.</creator><creator>O’Rahilly, S.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>200901</creationdate><title>Severe insulin resistance due to anti‐insulin antibodies: response to plasma exchange and immunosuppressive therapy</title><author>Greenfield, J. R. ; Tuthill, A. ; Soos, M. A. ; Semple, R. K. ; Halsall, D. J. ; Chaudhry, A. ; O’Rahilly, S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5441-2f4a5743781ac399a7749d6bcff7614e06abbc9a9b5f684d33fce54433f502803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Antigen-Antibody Reactions - immunology</topic><topic>anti‐insulin antibodies</topic><topic>Biological and medical sciences</topic><topic>diabetes</topic><topic>Diabetes Mellitus, Type 2 - blood</topic><topic>Diabetes Mellitus, Type 2 - drug therapy</topic><topic>Diabetes Mellitus, Type 2 - immunology</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Feeding. Feeding behavior</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. 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K.</creatorcontrib><creatorcontrib>Halsall, D. J.</creatorcontrib><creatorcontrib>Chaudhry, A.</creatorcontrib><creatorcontrib>O’Rahilly, S.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetic medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Greenfield, J. R.</au><au>Tuthill, A.</au><au>Soos, M. A.</au><au>Semple, R. K.</au><au>Halsall, D. J.</au><au>Chaudhry, A.</au><au>O’Rahilly, S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Severe insulin resistance due to anti‐insulin antibodies: response to plasma exchange and immunosuppressive therapy</atitle><jtitle>Diabetic medicine</jtitle><addtitle>Diabet Med</addtitle><date>2009-01</date><risdate>2009</risdate><volume>26</volume><issue>1</issue><spage>79</spage><epage>82</epage><pages>79-82</pages><issn>0742-3071</issn><eissn>1464-5491</eissn><coden>DIMEEV</coden><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.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>19125765</pmid><doi>10.1111/j.1464-5491.2008.02621.x</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Antigen-Antibody Reactions - immunology anti‐insulin antibodies Biological and medical sciences diabetes Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - drug therapy Diabetes Mellitus, Type 2 - immunology Diabetes. Impaired glucose tolerance Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Feeding. Feeding behavior Female Fundamental and applied biological sciences. Psychology Humans Immunosuppressive Agents - therapeutic use Injections, Subcutaneous - methods Insulin - blood Insulin - immunology Insulin Antibodies - blood Insulin Antibodies - immunology insulin resistance Insulin Resistance - immunology Medical sciences mycophenolate Mycophenolic Acid - analogs & derivatives Mycophenolic Acid - therapeutic use plasma exchange Plasma Exchange - methods Vertebrates: anatomy and physiology, studies on body, several organs or systems Vertebrates: endocrinology |
| title | Severe insulin resistance due to anti‐insulin antibodies: response to plasma exchange and immunosuppressive therapy |
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