Glargine Insulin Is Not an Alternative in Insulin Allergy

Abstract

A lthough the number of children and youth with type 2 diabetes is increasing, a clear case definition that describes children with type 2 diabetes at presentation remains elusive. Most initial diagnoses are decided on the clinical picture at presentation (1). Characteristics and risk factors have been outlined in several review and clinical articles (2-4). The purpose of this study was to describe the characteristics of youth presenting for an initial visit to the outpatient clinic of a large tertiary children's care center and diagnosed with type 2 diabetes.For this retrospective study, data were abstracted from a consecutive sample of 98 patients' medical records at Texas Children's Hospital starting 1 January 1998 and ending 31 October 2001. The sample's mean age at diagnosis was 13.6 years (SD 2.33; range 8.7-18.4 years). Fifty-one percent of the children were female and 49% were male (female: male ratio 1:1). For 43% race/ethnicity was not specified; the remaining participants were 28.6% African American, 22.4% Hispanic, 3.1% non-Hispanic white, and 3.1% Asian. Of those for whom data were available, a maternal history of type 2 diabetes was reported by 32.7% (18/55) and an unspecified type of diabetes by 12.7% (7/55). Twenty-seven percent (13/47) reported a father with type 2 diabetes and 21% (10/47) an unspecified type of diabetes.Mean BMI was 34.67 kg/m 2 (SD 6.91). Ninety-three percent had a BMI Ն95th percentile. All but three of the individuals had BMIs Ն85th percentile. Of those for whom data were recorded, acanthosis nigricans was identified in 94% (48/51). A Tanner stage of 3, 4, or 5 was identified in 73.2% (49/67).Blood pressure readings indicated that 49.4% (41/83) had a systolic (SBP) and 10.8% (9/83) a diastolic (DBP) Ն95th percentile for age, sex, and height (n ϭ 83). Fifty-five percent (46/83) had SBP and 19.3% (16/83) DBP readings Ն90th percentile for blood pressure. Of 72 pulse rates recorded, 2.6% were Ն95th percentile for age. Average HbA 1c was 10.38 (SD 3.52) (n ϭ 95).Of those who had symptoms documented in the medical record, 83.6% (56/ 67) reported polyuria, 83.9% (52/62) polydipsia , and 61% (36/59) polyphagia. Seventy-five percent reported both polyuria and polydipsia (46/61). Of the cases available, 46.2% (24/52) reported all three of the polys at initial presentation, 46.8% (29/62) had weight loss, and 62.5% (30/48) had ketones. Of those for whom islet cell antibody data were recorded (50/98), 49 had JDF units Ͻ5. Fifty-three percent were started on insulin, 46.3% on oral agents, and 13.7% on both insulin and oral agent (n ϭ 96). Initial mean insulin dose was 0.6 units/kg.Our sample is similar to those described in previous reports except for a more even ratio of female to male subjects, a greater percent with elevated SBP and/or DBP, and more individuals reporting weight loss. We are the first to report blood pressure by the 95th and 90th percentiles and the first to report pulse rate. These data contribute to the growing body of clinical evidence defining the characteristics of ...

Allergy reactions to insulin: effects of continuous subcutaneous insulin infusion and insulin analogues

“…However, glargine insulin can not always be considered as an alternative in insulin allergy. Indeed, the first report of allergy with glargine insulin has been described in an 81-year-old man with type 2 diabetes [61]. In that particular case, skin-prick tests were positive for human and porcine insulin as well as for lispro and glargine insulin, but not for aspart insulin.…”

“…The skin-prick tests were positive for human and porcine insulin forms and not for insulin aspart. Therefore, a treatment with CSII and insulin aspart was initiated and gave good results on the skin reactions and the metabolic control [61]. In a 25-year-old type 1 diabetic patient, after an initial diagnosis of protamine allergy, an allergy for all kinds of insulin (human, short-and long-acting analogues) was confirmed.…”

Allergy to Insulin Glargine: A Case Report

“…He had local induration and pruritus at the insulin injection site and generalized urticaria 10 to 15 min after the injection. Skin-prick tests (5 UI/ml) were positive for human and porcine insulin and insulin analogues, glargine and lispro, and negative for insulin aspart and all additives [16]. The second case described a type 2 diabetic patient who presented with local reactions and then anaphylactic shock after the introduction of insulin analogue premixes.…”

“…However, glargine cannot always be considered as an alternative in insulin allergy. Indeed, there are three cases in English literature describing allergy to insulin glargine [16][17][18]. The first case of allergy with glargine insulin was reported in 2003, an 81-year-old man with type 2 diabetes who presented with allergic reaction to Mixtard 30.…”

Hypersensitivity Reaction to Insulin Glargine and Insulin Detemir in a Pediatric Patient: A Case Report

“…In 2003, Durand-Gonzalez et al 21 described a patient who initially reacted to a regular NPH insulin mix but was also shown to be allergic to insulin glargine with skin testing. Additionally, this patient was allergic to insulin lispro but tolerated insulin aspart.…”