A Case of Newly Diagnosed Non-Insulin-Dependent Diabetes Associated with Immediate-Type Allergy Against Human Insulin

Abstract

A case of newly diagnosed non-insulin-dependent diabetes mellitus with immediate-type allergy against semisynthetic human insulin is reported. She experienced immediate-type allergy 2 months after initial insulin treatment. A skin test showed that she had allergy against the insulin itself but not the additives. The amino acid sequence of the semisynthetic human insulin was identical to that of endogenous native insulin and, moreover, the patient had not been treated with animal-derived insulin previously, so a structural change to the semisynthetic formulation at the injected subcutaneous site might have antigenicity. An H₁histamine blocker markedly diminished the skin reaction to insulin, and her plasma glucose and glycosylated hemoglobin A_Ic became well controlled. In summary, we experienced a diabetic patient with human insulin allergy at the time of initial insulin treatment, emphasizing that the possibility of human insulin allergy should be considered whenever a patient is started on insulin therapy.

An Epitaph for Sulfated Insulin: Immunologic profile of the last patients as they are switched from sulfated beef to human insulin

“…In accordance with the view that HI is less immunogenic than animal insulin, particularly beef insulin, it is possible that the majority of the patients would never have had clinically significant IIR if HI had been available for use earlier (5). However, even the highly purified HI preparations available today can still lead to immune complications (6). Recently, the insulin analog lispro (Lys [B28], Pro [B29]) has been used successfully to treat severe IIR, although the precise mechanism of its decreased immunogenicity remains uncertain (2).…”