Evidence-Based Treatment of Hypoglycemia in A Diabetic Patient with Insulin Autoantibody_Chinese Journal of Evidence-Based Medicine

Authors：

LI Yongheng ¹ , LV Lifang ¹ , WANG Chun ¹ , ZHOU Xiaofang ² , ZHONG Li ³ , CUI Lina ¹ ,  RAN Xingwu ¹

1. Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China;2. Endocrinology Department, People’s Hospital of Yuxi, Yuxi 653100, China;3. Endocrinology Department, People’s Hospital of Longquan District, Chengdu 610100, China;

Corresponding author：

RAN Xingwu, Email: ranxingwu@yahoo.com.cn

Keywords：

Hypoglycemia; Insulin autoantibody; Glucocorticoids; Evidence-based treatment

DOI：

10.7507/1672-2531.20100389

Video：

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Objective 　To identify the best therapy regimen for a patient with rare hypoglycemia due to insulin autoantibody (IAA).
Methods 　We searched The Cochrane Library (Issue 3, 2008), PubMed (1966-July 2009), EMbase (1974-July 2009) and CBM (1978-July 2009) to identify relevant evidence. The quality of the retrieved studies was critically assessed.
Results 　A total of 291 records were retrieved. No clinical guidelines, systematic reviews or clinical randomized studies were identified. Thirty treatment-related studies involving 6 interventions showed that insulin combined with Prednisone was relatively more effective and safer than conventional therapies.
Conclusion 　The steroid treatment might be useful for the improvement of glycamic control in patients with high IAA levels and severe hypoglycemia and hyperglycemia due to insulin antibodies raised against subcutaneously-injected human insulin.

Citation： LI Yongheng,LV Lifang,WANG Chun,ZHOU Xiaofang,ZHONG Li,CUI Lina,RAN Xingwu. Evidence-Based Treatment of Hypoglycemia in A Diabetic Patient with Insulin Autoantibody. Chinese Journal of Evidence-Based Medicine, 2010, 10(2): 223-226. doi: 10.7507/1672-2531.20100389 Copy

1.	Fineberg SE, Kawabata TT, Finco-Kent D, et al. Immunological responses to exogenous insulin. Endocr Rev, 2007, 28: 625-652.
2.	Uchigata Y, Hirata Y, Iwamoto Y. Drug-induced insulin autoimmune syndrome. Diabetes Res Clin Pract, 2009, 83(1): e19-20.
3.	Van Haeften TW. Clinical significance of insulin antibodies in insulin-treated diabetic patients. Diabetes Care, 1989, 12: 641-648.
4.	Lahtela JT, Knip M, Paul R, et al. Severe antibody-mediated human insulin resistance: successful treatment with the insulin analog lispro. Diabetes Care, 1997, 20: 71-73.
5.	Asai M, Kodera T, Ishizeki K, et al. Insulin lispro reduces insulin antibodies in a patient with type 2 diabetes with immunological insulin resistance. Diabetes Res Clin Pract, 2003, 61: 89-92.
6.	Dahl-Jorgensen K, Torjesen P, Hanssen KF, et al. Increase in insulin antibodies during continuous subcutaneous insulin infusion and multiple-injection therapy in contrast to conventional treatment. Diabetes,1987, 36: 1-5.
7.	Van Haeften TW, Krom BA, Gerich JE. Prolonged fasting hypoglycemia due to insulin antibodies in patients with non-insulindependent diabetes mellitus: effect of insulin withdrawal on insulinantibody- binding kinetics. Diabetes Care, 1987, 10: 160-163.
8.	Hara K, Tobe K, Uchigata Y, et al. Antibody-mediated insulin resistance treated by cessation of insulin administration. Intern Med, 2000, 39: 143-145.
9.	Virgili F, Frigato F, Magnanini PG, et al. Reduction in insulin antibodies 42 months after transfer from porcine to human monocomponent insulins. Diabetes Res, 1988, 9: 19-20.
10.	Jovanovic-Peterson L, Kitzmiller JL, Peterson CM. Randomized trial of human versus animal species insulin in diabetic pregnant women: improved glycemic control, not fewer antibodies to insulin, influences birth weight. Am J Obstet Gynecol, 1992, 167: 1325-1330.
11.	Ishizuka T, Ogawa S, Mori T, et al. Characteristics of the antibodies of two patients who developed daytime hyperglycemia and morning hypoglycemia because of insulin antibodies. Diabetes Res Clin Pract, 2009, 84(2): e21-23.
12.	Matsuyoshi A, Shimoda S, Tsuruzoe K, et al. A case of slowly progressive type 1 diabetes with unstable glycemic control caused by unusual insulin antibody and successfully treated with steroid therapy. Diabetes Res Clin Pract, 2006, 72: 238-243.
13.	Koyama R, Nakanishi K, Kato M, et al. Hypoglycemia and hyperglycemia due to insulin antibodies against therapeutic human insulin: treatment with double filtration plasmapheresis and prednisolone. Am J Med Sci, 2005, 329: 259-264.
14.	MacLeish SA, Wallace S, Madhun Z, et al. Treatment of hypoglycemia with intramuscular immunoglobulin in insulin dependent-diabetics with insulin antibodies. Journal of Allergy and Clinical Immunology, 2007, 119(1) Suppl 1: S18.
15.	Miyamura N, Murata Y, Taketa K, et al. A case of insulin autoimmune syndrome with HLA DRB1*0404: impact on the hypothesis for the molecular pathogenesis involving the DRB1 molecules. Diabetes Med, 2006, 23: 104-105.

1. Fineberg SE, Kawabata TT, Finco-Kent D, et al. Immunological responses to exogenous insulin. Endocr Rev, 2007, 28: 625-652.
2. Uchigata Y, Hirata Y, Iwamoto Y. Drug-induced insulin autoimmune syndrome. Diabetes Res Clin Pract, 2009, 83(1): e19-20.
3. Van Haeften TW. Clinical significance of insulin antibodies in insulin-treated diabetic patients. Diabetes Care, 1989, 12: 641-648.
4. Lahtela JT, Knip M, Paul R, et al. Severe antibody-mediated human insulin resistance: successful treatment with the insulin analog lispro. Diabetes Care, 1997, 20: 71-73.
5. Asai M, Kodera T, Ishizeki K, et al. Insulin lispro reduces insulin antibodies in a patient with type 2 diabetes with immunological insulin resistance. Diabetes Res Clin Pract, 2003, 61: 89-92.
6. Dahl-Jorgensen K, Torjesen P, Hanssen KF, et al. Increase in insulin antibodies during continuous subcutaneous insulin infusion and multiple-injection therapy in contrast to conventional treatment. Diabetes,1987, 36: 1-5.
7. Van Haeften TW, Krom BA, Gerich JE. Prolonged fasting hypoglycemia due to insulin antibodies in patients with non-insulindependent diabetes mellitus: effect of insulin withdrawal on insulinantibody- binding kinetics. Diabetes Care, 1987, 10: 160-163.
8. Hara K, Tobe K, Uchigata Y, et al. Antibody-mediated insulin resistance treated by cessation of insulin administration. Intern Med, 2000, 39: 143-145.
9. Virgili F, Frigato F, Magnanini PG, et al. Reduction in insulin antibodies 42 months after transfer from porcine to human monocomponent insulins. Diabetes Res, 1988, 9: 19-20.
10. Jovanovic-Peterson L, Kitzmiller JL, Peterson CM. Randomized trial of human versus animal species insulin in diabetic pregnant women: improved glycemic control, not fewer antibodies to insulin, influences birth weight. Am J Obstet Gynecol, 1992, 167: 1325-1330.
11. Ishizuka T, Ogawa S, Mori T, et al. Characteristics of the antibodies of two patients who developed daytime hyperglycemia and morning hypoglycemia because of insulin antibodies. Diabetes Res Clin Pract, 2009, 84(2): e21-23.
12. Matsuyoshi A, Shimoda S, Tsuruzoe K, et al. A case of slowly progressive type 1 diabetes with unstable glycemic control caused by unusual insulin antibody and successfully treated with steroid therapy. Diabetes Res Clin Pract, 2006, 72: 238-243.
13. Koyama R, Nakanishi K, Kato M, et al. Hypoglycemia and hyperglycemia due to insulin antibodies against therapeutic human insulin: treatment with double filtration plasmapheresis and prednisolone. Am J Med Sci, 2005, 329: 259-264.
14. MacLeish SA, Wallace S, Madhun Z, et al. Treatment of hypoglycemia with intramuscular immunoglobulin in insulin dependent-diabetics with insulin antibodies. Journal of Allergy and Clinical Immunology, 2007, 119(1) Suppl 1: S18.
15. Miyamura N, Murata Y, Taketa K, et al. A case of insulin autoimmune syndrome with HLA DRB1*0404: impact on the hypothesis for the molecular pathogenesis involving the DRB1 molecules. Diabetes Med, 2006, 23: 104-105.

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