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Exp Clin Endocrinol Diabetes 2004; 112(8): 416-421
DOI: 10.1055/s-2004-821186
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Diagnostic Algorithm and Management of Immune-Mediated Complications Associated with Subcutaneous Insulin Therapy[*]

C. Jaeger1 , M. Eckhard1 , M. D. Brendel1 , R. G. Bretzel1
  • 1Third Medical Department and Policlinic, Justus-Liebig University of Giessen, Germany
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Publication History

Publication Date:
16 September 2004 (online)

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Abstract

Immune mediated complications associated with subcutaneous insulin therapy such as insulin neutralizing antibodies and/or skin reactions are rare conditions since human insulin is in general use. Nevertheless, if it occurs, a stepwise diagnostic approach is essential for differential diagnosis and consecutive treatment of these complications. Here we suggest a diagnostic algorithm to deal with e.g. insulin antibody formation of the IgG and/or IgE type and/or severe skin reactions resulting in poor metabolic control and often “brittle diabetes” in affected patients. This diagnostic algorithm includes step 1: Intradermal skin testing with positive and negative controls, additives and different insulin preparations; step 2: Quantification of insulin specific IgG and IgE in the serum, and step 3: Analysis of the time dependent binding/dissociation curves of the insulin neutralizing antibodies in an ex vivo/in vitro assay to assess the clinical significance of these antibodies. Based on 158 insulin treated control subjects and four patients with typical symptoms and signs representing the spectrum of immune-mediated complications subsequent to subcutaneous insulin therapy we demonstrate that the proposed stepwise approach leads to a definite diagnosis as a prerequisite for individual and successful therapy.

Key words

Insulin antibodies - insulin allergy - insulin resistance - brittle diabetes - insulin therapy

1 In honour of Prof. Dr. Drs. h.c. K. Federlin on the occasion of his 75th birthday

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1 In honour of Prof. Dr. Drs. h.c. K. Federlin on the occasion of his 75th birthday

Dr. med. C. Jaeger

Third Medical Department and Policlinic
Justus-Liebig University of Giessen

Rodthohl 6

35392 Giessen

Germany

Phone: + 4906419942823

Fax: + 49 0 64 19 94 27 59

Email: clemens.jaeger@innere.med.uni-giessen.de

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