A case of insulin antibody-mediated insulin resistance in type 2 diabetes treated by glucocorticoid

Abstract

The syndromes of severe insulin resistance (IR), although rare, are very interesting and clinically important. It causes a deterioration of the glycemic control, despite the very high dose of insulin. One of the rarest etiologies is autoimmunity especially the production of insulin autoantibody. We report the case of a 61-year-old woman with a history of type 2 diabetes for 10 years. She has reported a deterioration of her glycemic control despite an increase in the dose of insulin up to 200U/day (d). The clinical examination was without particularity. There was no history of drug intake. A high titer of insulin antibodies was detected in the serum 77.6%. Prednisolone was administered with a dose of 0,5mg/Kg/d for 1month. The dosage was tapered 5mg at 15 days intervals until 5mg/d. Insulin requirement decreased by 66% and glycemic control was reached. The treatment of antibody-mediated IR is not standardized; corticosteroid therapy often gives good results.

Keywords

• diabetes mellitus
• glucocorticoids
• insulin
• insulin antibody
• insulin resistance