Abstract
A 59-year-old man was diagnosed with diabetes mellitus at 54 years of age. Insulin therapy with the insulin analog, aspart, was started two years later, because of poor glycemic control and drug-induced liver disease due to voglibose and nateglinide. The insulin therapy improved his glycemic control. He was admitted to the hospital at 58 years of age, because he developed fasting hypoglycemia and daytime hyperglycemia. Low affinity and high capacity serum insulin antibodies were found to be causing his unstable glycemic control. His glycemic control improved by changing the insulin therapy from aspart to lispro twice a day and eating a late evening snack. However, he was admitted for 24-hour glucose monitoring using CGM at 59 years of age, because daytime hyperglycemia occurred again. The results showed a shortage of midnight basal insulin and an overdose of evening insulin lispro. The evening dose of insulin lispro was reduced and NPH insulin was started at night. The success of these adjustments was confirmed using CGM. In conclusion, CGM was found to be beneficial for complicated diabetes treatment in patients with insulin antibodies.
