Abstract
A 67-year-old woman was diagnosed with type 2 diabetes mellitus at 40 years of age. Three years earlier, insulin therapy with biphasic insulin aspart 30 was initiated. She recently began to suffer from hypoglycemia in the early morning and was subsequently admitted to our hospital. The titer and insulin-binding capacity of insulin antibodies were high, and a scatchard analysis showed that the insulin antibodies had a larger capacity and weaker affinity in high-affinity binding sites compared with that observed in insulin antibody-positive patients under insulin treatment. Changing the insulin preparation did not ameliorate the hypoglycemia, while the withdrawal of insulin therapy resulted in more severe hyperglycemia in the daytime. Treatment with a combination of liraglutide and insulin analogue immediately attenuated the hypoglycemia in the morning and severe hyperglycemia in the daytime. A late scatchard analysis revealed changes in the characteristics of the insulin antibodies, thus suggesting one reason for the dissipation of the patient's hypoglycemia.
