2012 Volume 55 Issue 6 Pages 398-403
A 74-year-old man diagnosed with diabetes at age 51 and treated with oral hypoglycemic agents had increased HbA1c (JDS, 8.3 %) noted at age 71. Insulin therapy (Humalog Mix 50®) was started, resulting in good control (HbA1c <7 %). Unstable blood glucose levels were observed one year later, however, with morning hypoglycemia and daytime hyperglycemia. The blood IRI concentration was 2430 μU/ml and the insulin antibody binding rate 78.4 %. Scatchard plot analysis showed this antibody to have low affinity and high binding capacity. Changing the insulin product still left blood glucose levels unstable. During follow-up, the man developed a cerebral infarction. Discontinuing insulin to prevent insulin-antibody-induced hypoglycemia and changing to a GLP-1 receptor agonist improved glycemic control. This enabled glucose to be monitored continuously to visually and quantitatively assess circadian variation.
