Insulin allergy to detemir followed by rapid onset of diabetic ketoacidosis: a case report and literature review

The management of diabetes mellitus in an insulin-dependent patient is challenging in the setting of concomitant antibody-mediated-insulin hypersensitivity. We report a case of a 62-year-old woman with pre-existing type 2 diabetes mellitus of 10 years duration who developed type 3 hypersensitivity r...

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Main Authors: Teo, Chong Boon, Tan, Pek Yan, Lee, Shan Xian, Khoo, Joan, Tan, Jun Guan, Ang, Su Fen, Tan, Sze Hwa, Tay, Tunn Lin, Tan, Eberta, Lim, Su Chi, Boehm, Bernhard Otto, Loh, Wann Jia
Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
Format: Article
Language:English
Published: 2022
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Online Access:https://hdl.handle.net/10356/161468
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Institution: Nanyang Technological University
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spelling sg-ntu-dr.10356-1614682023-03-05T16:51:56Z Insulin allergy to detemir followed by rapid onset of diabetic ketoacidosis: a case report and literature review Teo, Chong Boon Tan, Pek Yan Lee, Shan Xian Khoo, Joan Tan, Jun Guan Ang, Su Fen Tan, Sze Hwa Tay, Tunn Lin Tan, Eberta Lim, Su Chi Boehm, Bernhard Otto Loh, Wann Jia Lee Kong Chian School of Medicine (LKCMedicine) Tan Tock Seng Hospital Science::Medicine Insulin Allergy Insulin Hypersensitivity The management of diabetes mellitus in an insulin-dependent patient is challenging in the setting of concomitant antibody-mediated-insulin hypersensitivity. We report a case of a 62-year-old woman with pre-existing type 2 diabetes mellitus of 10 years duration who developed type 3 hypersensitivity reaction to insulin analogue detemir, and subsequently, severe diabetic ketoacidosis (DKA). She was C-peptide negative and was diagnosed with insulin-dependent diabetes. Despite increasing dose adjustments, insulin-meal matching, and compliance with insulin, she experienced episodes of unexpected hyperglycaemia and hypoglycaemia. The development of rash after detemir initiation and rapid progression to DKA suggests an aberrant immune response leading to the insulin allergy and antibody-induced interference with insulin analogues. Glycaemic control in the patient initially improved after being started on subcutaneous insulin infusion pump with reduced insulin requirements. However, after a year on pump therapy, localised insulin hypersensitivity reactions started, and glycaemic control gradually deteriorated. Published version 2022-09-05T04:59:13Z 2022-09-05T04:59:13Z 2022 Journal Article Teo, C. B., Tan, P. Y., Lee, S. X., Khoo, J., Tan, J. G., Ang, S. F., Tan, S. H., Tay, T. L., Tan, E., Lim, S. C., Boehm, B. O. & Loh, W. J. (2022). Insulin allergy to detemir followed by rapid onset of diabetic ketoacidosis: a case report and literature review. Frontiers in Endocrinology, 13, 844040-. https://dx.doi.org/10.3389/fendo.2022.844040 1664-2392 https://hdl.handle.net/10356/161468 10.3389/fendo.2022.844040 35350098 2-s2.0-85127321517 13 844040 en Frontiers in Endocrinology © 2022 Teo, Tan, Lee, Khoo, Tan, Ang, Tan, Tay, Tan, Lim, Boehm and Loh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. application/pdf
institution Nanyang Technological University
building NTU Library
continent Asia
country Singapore
Singapore
content_provider NTU Library
collection DR-NTU
language English
topic Science::Medicine
Insulin Allergy
Insulin Hypersensitivity
spellingShingle Science::Medicine
Insulin Allergy
Insulin Hypersensitivity
Teo, Chong Boon
Tan, Pek Yan
Lee, Shan Xian
Khoo, Joan
Tan, Jun Guan
Ang, Su Fen
Tan, Sze Hwa
Tay, Tunn Lin
Tan, Eberta
Lim, Su Chi
Boehm, Bernhard Otto
Loh, Wann Jia
Insulin allergy to detemir followed by rapid onset of diabetic ketoacidosis: a case report and literature review
description The management of diabetes mellitus in an insulin-dependent patient is challenging in the setting of concomitant antibody-mediated-insulin hypersensitivity. We report a case of a 62-year-old woman with pre-existing type 2 diabetes mellitus of 10 years duration who developed type 3 hypersensitivity reaction to insulin analogue detemir, and subsequently, severe diabetic ketoacidosis (DKA). She was C-peptide negative and was diagnosed with insulin-dependent diabetes. Despite increasing dose adjustments, insulin-meal matching, and compliance with insulin, she experienced episodes of unexpected hyperglycaemia and hypoglycaemia. The development of rash after detemir initiation and rapid progression to DKA suggests an aberrant immune response leading to the insulin allergy and antibody-induced interference with insulin analogues. Glycaemic control in the patient initially improved after being started on subcutaneous insulin infusion pump with reduced insulin requirements. However, after a year on pump therapy, localised insulin hypersensitivity reactions started, and glycaemic control gradually deteriorated.
author2 Lee Kong Chian School of Medicine (LKCMedicine)
author_facet Lee Kong Chian School of Medicine (LKCMedicine)
Teo, Chong Boon
Tan, Pek Yan
Lee, Shan Xian
Khoo, Joan
Tan, Jun Guan
Ang, Su Fen
Tan, Sze Hwa
Tay, Tunn Lin
Tan, Eberta
Lim, Su Chi
Boehm, Bernhard Otto
Loh, Wann Jia
format Article
author Teo, Chong Boon
Tan, Pek Yan
Lee, Shan Xian
Khoo, Joan
Tan, Jun Guan
Ang, Su Fen
Tan, Sze Hwa
Tay, Tunn Lin
Tan, Eberta
Lim, Su Chi
Boehm, Bernhard Otto
Loh, Wann Jia
author_sort Teo, Chong Boon
title Insulin allergy to detemir followed by rapid onset of diabetic ketoacidosis: a case report and literature review
title_short Insulin allergy to detemir followed by rapid onset of diabetic ketoacidosis: a case report and literature review
title_full Insulin allergy to detemir followed by rapid onset of diabetic ketoacidosis: a case report and literature review
title_fullStr Insulin allergy to detemir followed by rapid onset of diabetic ketoacidosis: a case report and literature review
title_full_unstemmed Insulin allergy to detemir followed by rapid onset of diabetic ketoacidosis: a case report and literature review
title_sort insulin allergy to detemir followed by rapid onset of diabetic ketoacidosis: a case report and literature review
publishDate 2022
url https://hdl.handle.net/10356/161468
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