Successful Treatment of Unusual Case of Brittle Diabetes With Sulfated Beef Insulin

Davidson, Mayer B.; Kumar, Dinesh; Smith, W. G.

doi:10.2337/diacare.14.1.1109b

Cited by 5 publications

(6 citation statements)

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“…Instability has been described only in case reports and is characterized either by both hyperglycemia and hypoglycemia occurring within a single 24-h interval or by periods lasting days to weeks of hyperglycemia alternating with periods of hypoglycemia of similar duration (49, 176,178,223,229,239,290,291,341,342). Some of these case reports describe patients with relative overnight hypoglycemia and daytime hyperglycemia, although there is no clear mechanistic explanation for such diurnal patterns (see Section V.B.3.c).…”

Section: G Buffering Effect Of Insulin Antibodiesmentioning

confidence: 97%

Immunological Responses to Exogenous Insulin

et al. 2007

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Regardless of purity and origin, therapeutic insulins continue to be immunogenic in humans. However, severe immunological complications occur rarely, and less severe events affect a small minority of patients. Insulin autoantibodies (IAAs) may be detectable in insulin-naive individuals who have a high likelihood of developing type 1 diabetes or in patients who have had viral disorders, have been treated with various drugs, or have autoimmune disorders or paraneoplastic syndromes. This suggests that under certain circumstances, immune tolerance to insulin can be overcome. Factors that can lead to more or less susceptibility to humoral responses to exogenous insulin include the recipient's immune response genes, age, the presence of sufficient circulating autologous insulin, and the site of insulin delivery. Little proof exists, however, that the development of insulin antibodies (IAs) to exogenous insulin therapy affects integrated glucose control, insulin dose requirements, and incidence of hypoglycemia, or contributes to beta-cell failure or to long-term complications of diabetes. Studies in which pregnant women with diabetes were monitored for glycemic control argue against a connection between IAs and fetal risk. Although studies have shown increased levels of immune complexes in patients with diabetic microangiopathic complications, these immune complexes often do not contain insulin or IAs, and insulin administration does not contribute to their formation. The majority of studies have shown no relationship between IAs and diabetic angiopathic complications, including nephropathy, retinopathy, and neuropathy. With the advent of novel insulin formulations and delivery systems, such as insulin pumps and inhaled insulin, examination of these issues is increasingly relevant.

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Section: G Buffering Effect Of Insulin Antibodiesmentioning

confidence: 97%

Immunological Responses to Exogenous Insulin

et al. 2007

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“…Seven patients [1,3,4,[8][9][10] received immunosuppressant or plasmapheresis treatment, in addition to insulin cessation or switching to another insulin formulation. The other 8 patients [7,[11][12][13][14][15][16][17] resorted solely to removal of immunogenic insulin preparations and achieved remission in 3 weeks [17] to 1 year [16]. The favorable outcomes reveal that IA-induced hypoglycemia tends to be self-limited after cessation of allergenic insulins.…”

Section: Discussionmentioning

confidence: 96%

Medical Nutrition Therapy Is Effective in the Management of Hypoglycemia Caused by Insulin Antibodies: A Case Report and Literature Review

Mao

et al. 2015

Journal of the American College of Nutrition

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Autoimmune antibodies, induced by exogenous insulin preparations, may result in labile glucose control and frequent hypoglycemia in some rare cases. In addition to insulin cessation, immune suppressants and/or plasmapheresis have been used as the primary remedies for these patients. Some previous studies also indicate that the condition tends to remit spontaneously after discontinuation of insulin exposure. Because of this, the clinical importance of nutritional interventions and behavioral approaches, which may play a role in ameliorating the symptoms, should also be emphasized. Herein, we report on a 64-year-old man with hypoglycemia induced by insulin antibodies (IAs), whose hypoglycemic symptoms significantly improved after the implementation of nutrition therapy. This rare case expands our knowledge of the management of hypoglycemia, and for the first time highlights the significance of nutritional and lifestyle intervention in treatment of IA-induced hypoglycemia.

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“…Halbuki bizim olgumuzda intravenöz iıısülinden sonra plazma glukoz düşüşü sürmüştür Bu bize başlıca iki noktayı düşündürmekte-dir : İnsülin otoantikorları bir rezervuar oluştururlar. Bu reservuar bir taraftan insülin direncine yol açarken, diğer taraftan uygun olmayan zamanlarda insülin salmımma ve hipoglisemiye yol açar (1,5,6). Olgumuzda glisemi düzeyinde düşmenin sürmesi böyle bir rezervuardan insülin salınımı olduğunu düşündürüyordu.…”

Section: Discussionunclassified

“…DM'lu hasta grupları arasında nadir tarif edilen BDM'un tedavisinde her zaman başarılı olunamamaktadır (1,6). (Tablo IV) Bu çoğu kez gerçek nedenin tesbit edilememesine bağlıdır (1,6).…”

Section: Discussionunclassified