Murray Benjamin R, Jewell Jolene R, Jackson Kyle J, Agboola Olabunmi, Alexander Brianna R, Sharma Poonam
Duke University School of Medicine, 3643 N Roxboro Rd, Durham, NC, 27704, USA.
Duke University Hospital, Durham, NC, USA.
J Gen Intern Med. 2017 Jul;32(7):841-845. doi: 10.1007/s11606-017-4037-7. Epub 2017 Mar 23.
Management of type 1 diabetes in patients who have insulin hypersensitivity is a clinical challenge and places patients at risk for recurrent diabetic ketoacidosis (DKA). Hypersensitivity reactions can be due to the patient's response to the insulin molecule itself or one of the injection's non-insulin components. It is therefore crucial for clinicians to quickly recognize the type of hypersensitivity reaction that is occurring and identify potentially immunogenic additives for the purpose of directing therapy as various insulin preparations have differing ingredients. We present the case of a 23-year-old diabetic female with common variable immunodeficiency (CVID) and autoimmune enteropathy who developed a type III hypersensitivity reaction to multiple formulations of subcutaneous insulin after years of use and the challenges of devising a long-term management strategy.
对胰岛素过敏的1型糖尿病患者的管理是一项临床挑战，会使患者面临反复发生糖尿病酮症酸中毒（DKA）的风险。过敏反应可能是由于患者对胰岛素分子本身或注射剂的非胰岛素成分之一的反应。因此，临床医生快速识别正在发生的过敏反应类型并确定潜在的免疫原性添加剂以指导治疗至关重要，因为各种胰岛素制剂的成分不同。我们报告了一例23岁患有常见可变免疫缺陷（CVID）和自身免疫性肠病的糖尿病女性病例，该患者在多年使用皮下胰岛素的多种制剂后发生了III型过敏反应，以及制定长期管理策略所面临的挑战。
