Successful Treatment with Liraglutide in a Diabetic Patient with Widely Fluctuating Blood Glucose Levels due to the Formation of Insulin Antibodies

Abstract

A 68-year-old man who had been suffering from type 2 diabetes mellitus for 27 years was switched from sulfonylurea to biphasic insulin aspart in 2007. His blood glucose was initially well controlled. However, the HbA1c level suddenly increased eight months after the start of the insulin therapy. He experienced early morning hypoglycemia with excessive daytime hyperglycemia. Laboratory tests showed an elevated IRI of 4,830 μU/ml and an insulin-antibody binding rate of 92.8 %. As we attributed the blood glucose fluctuation to the presence of insulin antibodies, switching the medication regimen to other forms of insulin products and steroid pulse therapy was tried in vain. Despite the continuous administration of steroids, no long-term improvements were observed in either the insulin-antibody binding rate or blood glucose fluctuation. In December 2011, we discontinued the insulin therapy and initiated treatment with liraglutide, achieving an improvement in the blood glucose fluctuation. Four months later, laboratory tests showed a decreased insulin-antibody binding rate of 24.9 % and an IRI of 44.9 μU/ml. In July 2013, a further decrease in the insulin-antibody binding rate to 6.2 % was attained.