Antibody-Mediated Extreme Insulin Resistance: A Report of Three Cases

Han Na Kim, Betiel Fesseha, Laura Anzaldi, Allison Tsao, Panagis Galiatsatos, Aniket Sidhaye

Research output: Contribution to journalArticlepeer-review

Abstract

Background Type 2 diabetes mellitus is characterized by relative insulin deficiency and insulin resistance. Features suggesting severe insulin resistance include acanthosis nigricans, hyperandrogenism, weight loss, and recurrent hospital admissions for diabetic ketoacidosis. In rare circumstances, hyperglycemia persists despite administration of massive doses of insulin. In these cases, it is important to consider autoimmune etiologies for insulin resistance, such as type B insulin resistance and insulin antibody-mediated extreme insulin resistance, which carry high morbidity and mortality if untreated. Encouragingly, immunomodulatory regimens have recently been published that induce remission at high rates. Methods/Results We describe 3 cases of extreme insulin resistance mediated by anti-insulin receptor autoantibodies or insulin autoantibodies. All cases were effectively treated with an immunomodulatory regimen. Conclusion Although cases of extreme insulin resistance are rare, it is important to be aware of autoimmune causes, recognize suggestive signs and symptoms, and pursue appropriate diagnostic evaluation. Prompt treatment with immunomodulators is key to restoring euglycemia in patients with autoimmune etiologies of insulin resistance.

Original languageEnglish (US)
Pages (from-to)102-106
Number of pages5
JournalAmerican Journal of Medicine
Volume131
Issue number1
DOIs
StatePublished - Jan 2018

Keywords

  • Extreme insulin resistance
  • Insulin antibody-mediated extreme insulin resistance
  • Insulin receptor antibody
  • Type B insulin resistance

ASJC Scopus subject areas

  • Medicine(all)

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