A case of type 1 diabetes mellitus with which localized insulin allergy was markedly alleviated by switching to insulin glulisine

Acta Diabetologica, Feb 2016

Kahori Watanabe, Yoshiki Kusunoki, Tomoyuki Katsuno, Rie Nakae, Toshihiro Matsuo, Fumihiro Ochi, Masaru Tokuda, Takafumi Akagami, Masayuki Miuchi, Jun-ichiro Miyagawa, et al.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://link.springer.com/content/pdf/10.1007%2Fs00592-016-0841-5.pdf

A case of type 1 diabetes mellitus with which localized insulin allergy was markedly alleviated by switching to insulin glulisine

Acta Diabetol A case of type 1 diabetes mellitus with which localized insulin allergy was markedly alleviated by switching to insulin glulisine Kahori Watanabe 0 1 2 Yoshiki Kusunoki 0 1 2 Tomoyuki Katsuno 0 1 2 Rie Nakae 0 1 2 Toshihiro Matsuo 0 1 2 Fumihiro Ochi 0 1 2 Masaru Tokuda 0 1 2 Takafumi Akagami 0 1 2 Masayuki Miuchi 0 1 2 Jun-ichiro Miyagawa 0 1 2 Mitsuyoshi Namba 0 1 2 0 Division of Innovative Diabetes Treatment, Department of Internal Medicine, Hyogo College of Medicine , 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501 , Japan 1 Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Hyogo College of Medicine , 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501 , Japan 2 & Yoshiki Kusunoki Managed by Massimo Porta. Insulin glulisine; Insulin allergy; Skin allergological test; Continuous subcutaneous insulin infusion Introduction There have been numerous reports of allergies with causes such as differences in the amino acid sequences between human insulin and insulin extracted from porcine and bovine pancreas. Insulin allergy leads to deterioration of blood glucose control and decrease in quality of life. However, the availability of genetically recombinant human insulin formulations has led to insulin allergy becoming uncommon [ 1 ], and such allergies also occur much more rarely when insulin analog formulations are administered. The present report is about a patient who showed allergic reactions to various insulin formulations, but showed only a weak allergic reaction to insulin glulisine, so the symptoms of insulin allergy ceased when treatment was switched to insulin glulisine. The patient was a 28-year-old female with type 1 diabetes mellitus. In February 2011, she developed the subjective symptoms of oral dryness, polydipsia, and polyuria, although she did not consult a physician. In March 2011, her mother found her unconsciousness in her home, and she was taken as an emergency to a different hospital, where diabetic ketoacidosis and type 1 diabetes mellitus were diagnosed. Intensive insulin therapy was then initiated, using insulin aspart and insulin detemir. However, because of the instability of fluctuations in blood glucose level, the attending physician at that hospital recommended initiation of continuous subcutaneous insulin infusion (CSII), the patient was therefore referred to our hospital in April 2011, and CSII was initiated. She then continued to visit our hospital as an outpatient, and the hemoglobin A1c (HbA1c) level was maintained at approximately 6.5 % (48 mmol/mol) by means of CSII using insulin lispro. The patient had told only a few close friends about having type 1 diabetes mellitus, so, when she travelled with other friends, and work colleagues, she chose to control her blood glucose by multiple daily injections rather than CSII. In addition, she had expressed strong interest in different insulin formulations, and various formulations, including insulin glulisine, had therefore been tried. As basal insulin, she had a history of use of insulin detemir and insulin glargine. She had not previously had particular problems with any of these formulations. Since June 2015, the patient has developed the subjective symptoms of redness, swelling, and itchiness around the CSII cannula insertion site, and she was examined at our hospital in July. At that time, her blood glucose level was controlled by CSII with insulin lispro. At the time of examination, the casual blood glucose level was 157 mg/ dL, the HbA1c level was 6.3 % (45 mmol/mol), and the body mass index was 21.8 kg/m2. Examination showed erythema and induration at the cannula insertion site, so localized insulin allergy was suspected (Fig. 1a). Therefore, the IgE antibody specific to human insulin was measured, the concentration was found to be 2.32 UA/mL (normal range B 0.34 UA/mL), and the condition was judged to be class 2 (positive). The concentration of nonspecific IgE antibodies, on the other hand, was 21.8 IU/mL with no elevation (normal range B 173 IU/mL), and no eosinophilia was found (white blood cell count: 6410 cells/ lL; eosinophil percentage of white blood cell count: 0.6 %). Next, intradermal tests were carried using various insulin formulations. Each insulin formulation was diluted to 0.05 units per 0.05 mL with physiological saline solution, and 0.02 mL of the resulting solution was injected intradermally, followed by evaluation. The findings were that mild erythema measuring 5 9 5 mm developed 15 min after intradermal injection of insulin glulisine, whereas with other insulin formulations redness developed immediately after intradermal injection, and erythema at least 10 mm in diameter and induration at least 5 mm in diameter developed after 15 min (Table 1). All rashes cleared up within 24 h after the intradermal test. On the basis of the above findings, localized insulin allergy was suspected; so the cannula insertion site was changed, and a basal insulin rate of (...truncated)


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2Fs00592-016-0841-5.pdf

Kahori Watanabe, Yoshiki Kusunoki, Tomoyuki Katsuno, Rie Nakae, Toshihiro Matsuo, Fumihiro Ochi, Masaru Tokuda, Takafumi Akagami, Masayuki Miuchi, Jun-ichiro Miyagawa, Mitsuyoshi Namba. A case of type 1 diabetes mellitus with which localized insulin allergy was markedly alleviated by switching to insulin glulisine, Acta Diabetologica, 2016, pp. 845-848, Volume 53, Issue 5, DOI: 10.1007/s00592-016-0841-5