Moyes V, Driver R, Croom A, Mirakian R, Chowdhury T A
Department of Allergy, The Royal London Hospital, London, UK.
Diabet Med. 2006 Feb;23(2):204-6. doi: 10.1111/j.1464-5491.2006.01811.x.
Patients with poor control of Type 2 diabetes on maximum oral hypoglycaemic therapy invariably need insulin therapy. Insulin allergy is uncommon, particularly in patients with Type 2 diabetes. Management of the condition can be difficult, and here we report the case of a patient with Type 2 diabetes and insulin allergy successfully managed with a continuous subcutaneous insulin infusion (CSII).
A 60-year-old man was referred with insulin allergy. He had poorly controlled Type 2 diabetes (glycated haemoglobin 10.4%), on maximum doses of sulphonylurea and metformin, with osmotic symptoms. He was compliant with diet and tablets. His diabetes was complicated by retinopathy, nephropathy, coronary heart disease, obstructive sleep apnoea, obesity, depression and hypertension. He commenced on twice daily mixed insulin and, shortly after, developed pain, itching and erythema at the injection sites. The sites became indurated and tender, and he had constitutional symptoms. The insulin was changed to other preparations, including short- and long-acting analogues, with similar responses. Triple therapy with rosiglitazone was tried, with no improvement in control. Skin-prick testing confirmed allergy to insulin rather than additives. The patient was reluctant to undergo desensitization. He was commenced on an insulin pump in addition to his oral hypoglycaemics, and achieved fair control (glycated haemoglobin 8.3%) on 88 units of lispro per day, with little or no skin or systemic reaction.
This is the first case report of insulin allergy in Type 2 diabetes being successfully managed by CSII.
接受最大剂量口服降糖治疗但2型糖尿病控制不佳的患者最终需要胰岛素治疗。胰岛素过敏并不常见，尤其是在2型糖尿病患者中。这种情况的管理可能很困难，在此我们报告一例2型糖尿病合并胰岛素过敏的患者通过持续皮下胰岛素输注（CSII）成功治疗的病例。
一名60岁男性因胰岛素过敏前来就诊。他的2型糖尿病控制不佳（糖化血红蛋白10.4%），服用最大剂量的磺脲类药物和二甲双胍，伴有渗透性症状。他饮食和服药依从性良好。他的糖尿病并发视网膜病变、肾病、冠心病、阻塞性睡眠呼吸暂停、肥胖、抑郁症和高血压。他开始每日两次使用混合胰岛素，不久后注射部位出现疼痛、瘙痒和红斑。注射部位变硬且压痛，他还出现全身症状。胰岛素更换为其他制剂，包括短效和长效类似物，反应相似。尝试使用罗格列酮三联疗法，但血糖控制无改善。皮肤点刺试验证实对胰岛素过敏而非对添加剂过敏。患者不愿接受脱敏治疗。除口服降糖药外，他开始使用胰岛素泵，每天使用88单位赖脯胰岛素，血糖控制良好（糖化血红蛋白8.3%），几乎没有皮肤或全身反应。
这是首例关于2型糖尿病胰岛素过敏通过CSII成功治疗的病例报告。
