Diabetic Come Due to Insulin Resistance Associated with Insulin Allergy: A Case Report

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  • 全身性インスリンアレルギーを伴い，インスリン抵抗性による糖尿病性こん睡をきたした１例
  • ゼンシンセイ インスリン アレルギー オ トモナイ インスリン テイコウセイ

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Insulin resistance and generalized insulin allergy seldom occur in the same individual during insulin therapy. We report here the occurrence of diabetic coma due to insulin resistance following generalized insulin allergy. The patient was a 57-yr-old woman who was started on NPH insulin therapy for a second time. On the 9th day of insulin therapy, she developed generalized urticaria which lasted for 2 days during which time insulin therapy was continued. On day 13, she developed ketoacidosis. She received 450 units of Regular insulin and a fluid and electrolyte replacement for the first 10 hours, but the arterial pH and base excess did not change and she became comatose. Subsequently, she was begun on an increased dose of Actrapid insulin because of suspected immunologic resistance to Regular insulin. This treatment was followed by a prompt normalization of blood sugar and ketoacidosis, and the patient recovered completely. The intradermal direct skin test, Prausnitz-Küstner test and radioallergosorbent test were all positive against various insulins. On the other hand, the 125I-insulin binding rate, total and free IRI levels were 67.1%, over 900 mcU/ml and 32 mcU/ml, respectively, just before Regular insulin was switched to Actrapid insulin but thereafter, the free IRI levels increased to over 320 mcU/ml consistent with rapid normalization of the clinical data. These results indicate that anti-insulin IgE antibody and insulin binding antibody were respectively responsible for the occurrence of insulin allergy and insulin resistance in this patient.

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