Department of General Medicine, Nizam's Institute of Medical Sciences, Hyderabad, India.
Department of Endocrinology, Nizam's Institute of Medical Sciences, Hyderabad, India.
Diabetes Technol Ther. 2021 Mar;23(3):227-229. doi: 10.1089/dia.2020.0438.
Anti-insulin antibodies (IAs) in patients with insulin-treated diabetes, though common, correlate poorly with glycemic control, insulin requirement, and insulin resistance. We are hereby reporting the clinical course and challenges in the management of a 70-year-old man who had severe insulin resistance as evidenced by recurrent diabetic ketoacidosis and poor glycemic control despite treatment with >9 U of insulin/kg body weight per day. He was found to have anti-IAs and responded clinically to plasmapheresis and immunosuppression with mycophenolate mofetil and prednisolone. Improved glycemic control correlated well with falling titers of antibodies. This case emphasizes that clinicians should be alert to the possibility of insulin resistance due to anti-IAs and the role of immunosuppression and plasmapheresis in such cases.
在接受胰岛素治疗的糖尿病患者中，抗胰岛素抗体（IAs）虽然很常见，但与血糖控制、胰岛素需求和胰岛素抵抗相关性差。我们在此报告了一例 70 岁男性的临床病程和管理挑战，该患者存在严重的胰岛素抵抗，表现为反复发生糖尿病酮症酸中毒和血糖控制不佳，尽管每天接受 >9U/kg 体重的胰岛素治疗。他被发现存在抗 IAs，并对血浆置换和免疫抑制治疗（包括霉酚酸酯和泼尼松龙）有临床反应。血糖控制的改善与抗体滴度的下降密切相关。本病例强调了临床医生应该警惕由于抗 IAs 引起的胰岛素抵抗的可能性，以及免疫抑制和血浆置换在这种情况下的作用。
