Severe Insulin-resistant Diabetes due to Insulin Antibodies Associated with Eosinophilia

Abstract

A 66-year-old man with type 2 diabetes on hemodialysis treatment was admitted due to poor glycemic control. His serum insulin level and the 125 I-insulin binding rate were extremely high with an increased eosinophil count, although he did not have an allergic reaction to insulin or an elevation of specific IgE for human insulin. A Scatchard analysis revealed that the patient's insulin antibodies had a low affinity constant and a high binding capacity. Prednisolone administration decreased the eosinophil count and 125 I-insulin binding rate; accordingly, the glycemic control improved. Corticosteroid therapy may be a potent therapeutic strategy for insulin antibody-induced severe insulin resistance with eosinophilia.

Relationship between anti-insulin antibody production and severe insulin resistance in a diabetic cat

“…In those studies, patients' 125 I-insulin-binding rates were measured to assess AIA production. After prednisolone treatment, the 125 I-insulin-binding rate decreased from 54% to 23% [7] and from 83.5% to <4% [19].…”

Severe insulin resistance due to insulin antibodies

“…Some studies have reported cases of severe insulin resistance (IR) secondary to insulin antibodies, with several treatment methods showing some success . Herein, we report on a 58‐year‐old Chinese woman with a 14‐year history of type 2 diabetes with severe diabetic ketoacidosis (DKA) due to insulin antibodies.…”

Relationship between anti-insulin antibody production and severe insulin resistance in a diabetic cat

“…As such, temporal reduction of insulin-binding IgG did not accompany the amelioration of clinical signs. In human study, severe insulin-resistant diabetic patients with AIA production have been reported [ 7 , 19 , 21 ]. In those studies, patients’ 125 I-insulin-binding rates were measured to assess AIA production.…”

“…In those studies, patients’ 125 I-insulin-binding rates were measured to assess AIA production. After prednisolone treatment, the 125 I-insulin-binding rate decreased from 54% to 23% [ 7 ] and from 83.5% to <4% [ 19 ]. Meanwhile, non-insulin-resistant diabetic patients exhibited 125 I-insulin-binding rate <10% [ 21 ].…”

“…Meanwhile, non-insulin-resistant diabetic patients exhibited 125 I-insulin-binding rate <10% [ 21 ]. Furthermore, insulin antibody properties (affinity constant and binding capacity) did not change before and after prednisolone treatment [ 19 ]. In those three reports, insulin resistance was improved immediately after prednisolone treatment [ 7 , 19 , 21 ].…”