A Case of Type 2 Diabetes Mellitus Showing both Allergic Reaction due to Specific IgE for Insulin and Hypoglycemia due to Insulin Antibody during Analogue Insulin Treatment

Abstract

We treated a 50-year-old man with type 2 diabetes mellitus using human recombinant insulin after recession twice from human insulin and human recombinant insulin treatment. He showed an allergic reaction at the injection site of human recombinant insulin several days after the start of treatment. Marked elevation of specific IgE antibody against human insulin was observed. Skin test for allergy was positive for both human insulin and human recombinant insulin. In addition, the patient suffered from hypoglycemic episodes, mainly before dinner. Even after the insulin injections were stopped, the hypoglycemic episodes continued for 3 weeks. Laboratory data showed a high titer of insulin antibody in the serum. This persisted for 1 year after the insulin injections were stopped, and was possibly the cause of hypoglycemia. To the best of our knowledge, this is a rare case with IgE-type allergic reaction and IgG-type antibody against human recombinant insulin.