Diagnosis and treatment of anti‐insulin antibody‐mediated labile glycaemia in insulin‐treated diabetes
Authors' conclusion
Anti-insulin antibodies should be considered in insulin-treated diabetes with unexplained glycaemic lability. Combining immunoassays with PEG precipitation can stratify their significance. Antibody depletion may be beneficial, but conservative measures often suffice.
Study context
- Population
- People with insulin-treated diabetes and combinations of insulin resistance, nocturnal/matutinal hypoglycaemia and unexplained ketoacidosis
- Participants
- 40 people
- Outcome
- Antibody significance stratified by insulin immunoreactivity (IIR), PEG precipitation and gel filtration chromatography (GFC)
Performance
As reported in the abstract
- Insulin immunoreactivity (IIR) <3000 pmol/L, fell <50% after polyethylene glycol (PEG); antibodies judged insignificant
- 27 people
- IIR >3000 pmol/L, fell >50% after PEG; antibodies judged likely significant
- 8 people
- Substantial high molecular weight (HMW) IIR on gel filtration chromatography (GFC) among the 8
- 7 of these 8
- IIR <3000 pmol/L but fell >50% after PEG
- 5 participants
- Low HMW IIR on GFC, significance indeterminate
- 4 of these
Further findings
Management of likely significant antibodies
- Immunosuppression introduced (good clinical result in one, only biochemical response in another)
- 2 people
- Insulin delivery adjustment informed by knowledge of antibody
- 6 people
Original publication
Diagnosis and treatment of anti‐insulin antibody‐mediated labile glycaemia in insulin‐treated diabetes. Diabet Med. Published 1 September 2023. doi:10.
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