A Case of Type 2 Diabetes Mellitus with Polymyalgia Rheumatica Successfully Treated with Long-Term Corticosteroid Administration for Nocturnal Hypoglycemia Possibly Caused by Insulin Antibody

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  • インスリン抗体による夜間低血糖に長期的なステロイド治療が奏功したリウマチ性多発筋痛症併発糖尿病の1例
  • 症例報告 インスリン抗体による夜間低血糖に長期的なステロイド治療が奏功したリウマチ性多発筋痛症併発糖尿病の1例
  • ショウレイ ホウコク インスリン コウタイ ニ ヨル ヤカン テイケットウ ニ チョウキテキ ナ ステロイド チリョウ ガ ソウコウ シタ リウマチセイ タハツキンツウショウ ヘイハツ トウニョウビョウ ノ 1レイ

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Abstract

A-76-year man diagnosed with type 2 diabetes mellitus in 1993 was initially treated through diet and exercise, then with an oral hypoglycemic agent (OHA) in October 2005 due to poor blood glucose control. Polymyalgia rheumatica developing in November 2005 led to corticosteroid therapy, with the OHA changed simultaneously to insulin. Nocturnal hypoglycemia occurred three months later and a subcutaneous mass appeared at the insulin injectionsite. Insulin antibody was detected and the binding rate was 92.7 % in November 2007. Glycemic control remained poor despite insulin dose adjustment and change in the insulin type. The man was admitted in October 2009 and high-dose mPSL of 250 mg/day for three days started. This was followed with PSL of 30 mg/day for two weeks. Two years ofter corticosteroid therapy was started, PSL administration of 5 mg/day was continued and nocturnal hypoglycemia disappeared. The insulin antibody binding rate decreased and antibody affinity improved, as was confirmed in Scatchard analysis. In this case, corticosteroid therapy successfully improved a long-term glycemic daily profile caused by insulin antibody, as reported together with a comparison of cases.<br>

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