Two Cases of Allergy to Insulin in Gestational Diabetes

Abstract

Allergic reaction to insulin is uncommon since the introduction of human recombinant insulin preparations and is more rare in pregnant than non-pregnant females due to altered immune reaction during pregnancy. Herein, we report two cases of allergic reaction to insulin in gestational diabetes that were successfully managed. One case was a 33-year-old female using isophane-neutral protamine Hagedorn human insulin and insulin lispro. She experienced dyspnea, cough, urticaria and itching sensation at the sites of insulin injection immediately after insulin administration. We discontinued insulin therapy and started oral hypoglycemic agents with metformin and glibenclamide. The other case was a 32-year-old female using insulin lispro and insulin detemer. She experienced pruritus and burning sensation and multiple nodules at the sites of insulin injection. We changed the insulin from insulin lispro to insulin aspart. Assessments including immunoglobulin E (IgE), IgG, eosinophil, insulin antibody level and skin biopsy were performed. In the two cases, the symptoms were resolved after changing the insulin to oral agents or other insulin preparations. We report two cases of allergic reaction to human insulin in gestational diabetes due to its rarity.

Faulty Injection Technique: A Preventable But Often Overlooked Factor in Insulin Allergy

“…Though systemic corticosteroids can be used for symptom relief, they aggravate hyperglycemia, and changing the insulin to oral hypoglycemic agents may not possible in cases of type 1 or a long-standing insulinopenic spectrum of type 2 diabetes, as in this patient. Changing the insulin preparation to another preparation has also been used with success due to subtle differences in amino acid sequences and antigenicities between different insulins [ 4 , 5 ].…”

Allergy to Insulin Analogs in Gestational Diabetes

“…In clinical practice, cases of allergic reaction to insulin administration are uncommon and even more so in pregnant women, who have an altered immune response due to the physiologic changes that occur during pregnancy. In fact, only a few isolated cases of insulin allergy have been reported worldwide in women with GDM [3][4][5] . We describe the case of a 41-year-old woman who developed GDM and was referred around 24 weeks of gestation.…”