Immunological Insulin Resistance to Human Insulin/Insulin Aspart and Effective Treatment with Insulin Lispro in a Patient with Type 2 Diabetes

Kubo Tadashi, Goto Rie, Takagi Masatoshi

doi:10.11213/tonyobyo.50.145

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Other Title

ヒトインスリン/インスリンアスパルトへの重篤なインスリン抵抗性が生じ，インスリンリスプロが著効した2型糖尿病の1例
ヒトインスリン/インスリンアスパルトへの重篤なインスリン抵抗性が生じ,インスリンリスプロが著効した2型糖尿病の1例--抗体の質的検討
ヒトインスリンインスリンアスパルトエノジュウトクナインスリンテイコウセイガショウジインスリンリスプロガチョコウシタ 2ガタトウニョウビョウノ 1レイコウタイノシツテキケントウ
—抗体の質的検討—
—Qualitative Analysis of Insulin Antibodies—

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Abstract

An 84-year-old man with type 2 diabetes treated with human insulin from April 2000 to January 2003 experienced a progressive daily insulin dose increase up to 80 U/day during this period and ¹²⁵I-insulin binding was 96%. His regimen was converted from human insulin to almost the same dose of insulin aspart. In July 2004, his blood glucose rose abruptly (FBG>300 mg/dl) and could not be controlled even with more than 90 units of insulin aspart. We then treated him with insulin lispro, after which his blood glucose rapidly decreased and was well controlled with 12 U of insulin lispro 3 times daily before each meal. We found that insulin antibodies specific to insulin aspart were 15.1% and cross-reacting to human insulin/insulin aspart were 47.2%.<br>Scatchard analysis of insulin antibodies showed a low-affinity constant and an extremely high binding capacity of high-affinity sites. Insulin antibody binding resembled that in insulin autoimmune syndrome. We concluded that he developed severe immunological insulin resistance caused mainly by antibodies cross-reacting to human insulin/insulin aspart. Insulin lispro seemed less reactive to his antibodies and was effective for his glycemic control.

Journal

Journal of the Japan Diabetes Society

Journal of the Japan Diabetes Society 50 (2), 145-152, 2007

THE JAPAN DIABETES SOCIETY

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