ABSTRACT
We describe a 54-year-old Japanese female with type 2 diabetes admitted to our hospital with poor metabolic control. On admission the patient's HbA1c was 9.1% despite having taken over 60 U of human insulin per day for the previous 10 years. A high titer of antibodies to insulin was detected in the serum, and therefore, we decided to introduce insulin lispro with the aim of minimizing immunogenicity. Over the next 2 months, the dosage of insulin required to achieve reasonable blood glucose control was reduced, with the HbA1c level decreasing significantly to 6.8%. The patient was subsequently withdrawn from insulin and discharged on diet therapy only. This case demonstrates that insulin lispro may ameliorate resistance to insulin therapy even in the presence of human insulin antibodies.
Subject(s)
Autoantibodies/blood , Diabetes Mellitus, Type 2/immunology , Hypoglycemic Agents/pharmacology , Insulin Resistance/immunology , Insulin/analogs & derivatives , Insulin/immunology , Insulin/pharmacology , Diabetes Mellitus, Type 2/drug therapy , Female , Glucose/metabolism , Humans , Hypoglycemic Agents/immunology , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Insulin Lispro , Middle AgedABSTRACT
OBJECTIVE: Orthostatic hypotension is caused by autonomic nerve dysfunction, mainly by severe sympathetic nerve dysfunction in diabetic patients. Diabetes affects the peripheral nerves in a length-dependent manner. Quantitative sudomotor axon reflex test (QSART) is one of the sensitive tests for detecting sympathetic nerve function. We examined the relation between orthostatic hypotension and QSART at the foot and hand in type 2 diabetic patients. METHODS: Thirty-eight type 2 diabetic patients (age, 48.9 +/- 11.9 years; duration of diabetes, 13.4 +/- 8.6 years) and 13 age-matched non-diabetic controls were evaluated. All subjects aged under 65 years old were recruited. All subjects underwent Schellong tests and quantitative sudomotor axon reflex tests (QSART) at the back of the hand and dorsum of the foot. RESULTS: The sweating volume at the foot dorsum, but not the back of the hand, during the first 10 minutes of QSART was significantly related to the orthostatic hypotension on the Schellong test. In patients with normal, borderline and abnormal blood pressure response to standing, 6 out of 17 (35.3%), 9 out of 12 (75.0%) and 9 out of 9 (100%) had decreased sweating volume of the foot dorsum, respectively. CONCLUSIONS: Our results suggest that orthostatic hypotension may be detected early by QSART at the dorsum of the foot in type 2 diabetic patients.
