Frequent Reoccurrence of Hypoglycemia in a Type 2 Diabetic Patient with Insulin Antibodies
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CASE REPORT
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Frequent Reoccurrence of Hypoglycemia in a Type 2 Diabetic Patient with Insulin Antibodies Tie-Yun Zhao,1 Fang Li 1 and Zhong-Yun Xiong2 1 Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China 2 Laboratory Medicine Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
Abstract
Background: Insulin antibody (IAb) may be produced in patients receiving long-term, animal-derived insulin, leading to insulin resistance or hypoglycemia. There have been very few reports of hypoglycemia caused by IAb in patients taking recombinant human insulin. Case Report: We report the case of an 82-year-old male patient with type 2 diabetes mellitus who suffered repeated episodes of severe hypoglycemia-related symptoms (including coma) prior to admission. The patient had been taking Novolin 30R, a premixed human insulin. The patient’s IAb level was markedly elevated, and hypoglycemia caused by recombinant human insulin treatment-induced IAb production was diagnosed. Acarbose and metformin were prescribed, and the patient recovered uneventfully. The patient ceased taking these medications, and he was subsequently treated with recombinant human insulin to combat hyperglycemia. This was followed by reoccurrence of hypoglycemic coma. The patient was advised to avoid taking recombinant human insulin for the rest of his life and to control hyperglycemia with acarbose and metformin. Conclusions: Although rare, hypoglycemia caused by recombinant human insulin-induced IAb production should be considered in patients with type 2 diabetes who experience repeated episodes of hypoglycemia.
1. Introduction Hypoglycemia is common in diabetic patients and has been found to be associated with an increased length of hospital stay and higher mortality.[1] A longer duration of hypoglycemia is known to be associated with adverse outcomes.[2] It is not uncommon for hypoglycemia to be caused by an excessive dose of recombinant human insulin in patients with type 2 diabetes mellitus. This may be alleviated by insulin dose reduction or insulin withdrawal. Insulin antibody (IAb) is often produced in patients receiving long-term animal-derived insulin treatment, leading to insulin resistance or hypoglycemia.[3,4] There have been very few reports published concerning recombinant human insulin-induced IAb production. In cases where this has been described, the IAb concentration is usually low and of no clinical significance.[5-7] Herein we report the case of a type 2 diabetic patient receiving long-term recombinant human insulin treatment in whom IAb production resulted in repeated, serious episodes of hypoglycemia.
2. Case Report An 82-year-old male patient had been diagnosed with type 2 diabetes 15 years prior to presentation. Five years prior to presentation, the patient began to take Novolin R (biosynthetic human insulin) and Novolin N (isophane protamine biosynthetic human insulin) [Novo Nordisk A/S, Bagsvaerd, Den
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