Kato Takehiro, Iizuka Katsumi, Niwa Hiroyuki, Takeda Jun
Department of Diabetes and Endocrinology, Graduate School of Medicine, Gifu University, Gifu, Japan.
BMJ Case Rep. 2016 Jul 20;2016:bcr2016216028. doi: 10.1136/bcr-2016-216028.
Insulin antibodies sometimes cause glucose instability. A 52-year-old male patient was admitted to our department for the treatment of diabetes mellitus. From October 2003, he received insulin treatment for autoimmune pancreatitis and diabetes mellitus, but his hemoglobin A1c (HbA1c) levels gradually reached 8.0% (64 mmol/mol IFCC). In January 2010, insulin glargine and insulin aspart were introduced. In April 2010, the insulin antibody titre rose to >13.6 U/mL. In July 2010, treatment was changed to insulin glargine, metformin and miglitol. In November 2011, a further change to insulin glargine, metformin and sitagliptin was made. The insulin antibody titres gradually decreased, but HbA1c levels remained high. In November 2014, liraglutide and insulin glargine were introduced and the HbA1c levels decreased dramatically to ∼7.5% (58 mmol/mol IFCC) despite increasing insulin antibody titres (from 32.6 to >50.0 U/mL). Liraglutide successfully improved glycaemic instability due to insulin antibodies without modulating plasma insulin levels.
胰岛素抗体有时会导致血糖不稳定。一名52岁男性患者因糖尿病入住我科。自2003年10月起，他因自身免疫性胰腺炎和糖尿病接受胰岛素治疗，但其糖化血红蛋白（HbA1c）水平逐渐升至8.0%（国际临床化学联合会单位为64 mmol/mol）。2010年1月，开始使用甘精胰岛素和门冬胰岛素。2010年4月，胰岛素抗体滴度升至>13.6 U/mL。2010年7月，治疗方案改为甘精胰岛素、二甲双胍和米格列醇。2011年11月，进一步改为甘精胰岛素、二甲双胍和西格列汀。胰岛素抗体滴度逐渐下降，但HbA1c水平仍居高不下。2014年11月，开始使用利拉鲁肽和甘精胰岛素，尽管胰岛素抗体滴度升高（从32.6升至>50.0 U/mL），但HbA1c水平大幅降至约7.5%（国际临床化学联合会单位为58 mmol/mol）。利拉鲁肽成功改善了因胰岛素抗体导致的血糖不稳定，且未调节血浆胰岛素水平。
