Top

Published in:

Open Access 01-12-2016 | Case report

The effects of liraglutide on both hypereosinophilic insulin allergy and the characteristics of anti-insulin antibodies in type 2 diabetes mellitus: a case report

Authors: Hiroyuki Hirai, Emi Ogata, Nobuyuki Kikuchi, Teruyuki Kohno, Noritaka Machii, Koji Hasegawa, Tsuyoshi Watanabe, Hiroaki Satoh

Published in: Journal of Medical Case Reports | Issue 1/2016

Abstract

Background

Liraglutide is one of the glucagon-like peptide-1 analogs; there are only a few reports of liraglutide being used for the treatment of insulin allergy. Furthermore, anti-insulin immunoglobulin G antibodies are occasionally detected in patients with diabetes. Hence, we report a case in which switching to liraglutide therapy ameliorated both the symptoms of insulin allergy with hypereosinophilia and the characteristics of insulin antibodies in a patient with type 2 diabetes mellitus.

Case presentation

We present the case of a 70-year-old Japanese man with type 2 diabetes who developed insulin allergy with hypereosinophilia. Anti-insulin antibodies, high glycated hemoglobin levels (approximately 12 %), and high serum insulin levels were detected. Because a change in his insulin treatment was inefficient, treatment with liraglutide to protect residual insulin secretion was started, resulting in improvements in his insulin allergy, serum glycated hemoglobin, insulin, and eosinophil levels. Scatchard plots revealed decreased binding capacity and increased affinity constant for high affinity sites of anti-insulin antibodies.

Conclusions

Liraglutide might be useful for treating insulin allergy and anti-insulin antibodies in patients with type 2 diabetes.

Ghazavi MK, Johnston GA. Insulin allergy. Clin Dermatol. 2011;29(3):300–5.CrossRefPubMed

Heinzerling L, Raile K, Rochlitz H, Zuberbier T, Worm M. Insulin allergy: clinical manifestations and management strategies. Allergy. 2008;63(2):148–55.CrossRefPubMed

Blanco C, Castillo R, Quiralte J, Delgado J, García I, de Pablos P, et al. Anaphylaxis to subcutaneous neutral protamine Hagedorn insulin with simultaneous sensitization to protamine and insulin. Allergy. 1996;51(6):421–4.PubMed

Seino Y, Yabe D. Glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1: Incretin actions beyond the pancreas. J Diabetes Investig. 2013;4(2):108–30.CrossRefPubMedPubMedCentral

Kawanami D, Ito T, Watanabe Y, Kinoshita J, Sakamoto M, Isaka T, et al. Successful control of a case of severe insulin allergy with liraglutide. J Diabetes Investig. 2013;4(1):94–6.CrossRefPubMed

Fujishiro M, IzumidaY, Takemiya S, Kuwano Y, Takamoto I, Suzuki R, Yamauchi T, Ueki K, Kadowaki T. A case of insulin allergy successfully managed using multihexamer-forming insulin degludec combined with liraglutide. Diabet Med. 2015 Oct 20. doi:10.1111/dme.12998.

Berson SA, Yalow RS, Bauman A, Rothschild MA, Newerly K. Insulin-I¹³¹ metabolism in human subjects: demonstration of insulin binding globulin in the circulation of insulin treated subjects. J Clin Invest. 1956;35(2):170–90.CrossRefPubMedPubMedCentral

Iizuka K, Tomita R, Horikawa Y, Takeda J. A case of glycemic instability and insulin allergy due to anti-insulin antibodies in a patient with type 2 diabetes. Diabetol Int. 2012;3(4):233–8.CrossRef

Yamada H, Asano T, Kusaka I, Kakei M, Ishikawa S. Type B insulin resistance syndrome with fasting hypoglycemia and postprandial hyperglycemia. Diabetol Int. 2015;6(2):144–48.CrossRef

10.

Blanchard C, Marc E. Rothenberg biology of the eosinophil. Adv Immunol. 2009;101:81–121.CrossRefPubMedPubMedCentral

11.

Roufosse F, Weller P. Practical approach to the patient with hypereosinophilia. J Allergy Clin Immunol. 2010;126(1):39–44.CrossRefPubMedPubMedCentral

12.

Nagai Y, Mori T, Abe T, Nomura G. Immediate-type allergy against human insulin associated with marked eosinophilia in type 2 diabetic patient. Endocr J Jun. 2001;48(3):311–6.CrossRef

13.

Uriuhara A, Morita S, Kuroda S, Fumoto M, Araki S, Aoyama N, et al. Severe insulin-resistant diabetes mellitus associated with hypereosinophilic syndrome. Intern Med. 1994;33(10):632–6.CrossRefPubMed

14.

Nagai T, Nagai Y, Tomizawa T, Mori M. Immediate-type human insulin allergy successfully treated by continuous subcutaneous insulin infusion. Intern Med. 1997;36(8):575–8.CrossRefPubMed

15.

Matheu V, Perez E, Hernández M, Díaz E, Darias R, González A, et al. Insulin allergy and resistance successfully treated by desensitisation with aspart insulin. Clin Mol Allergy. 2005;23(3):16.CrossRef

16.

Malaise J, Leonet J, Goffin E, Lefebvre C, Tennstedt D, Vandeleene B, et al. Pancreas transplantation for treatment of generalized allergy to human insulin in type 1 diabetes. Transplant Proc. 2005;37(6):2839.CrossRefPubMed

17.

Cavelti-Weder C, Muggli B, Keller C, Babians-Brunner A, Biason-Lauber A, Donath MY, et al. Successful use of omalizumab in an inadequately controlled type 2 diabetic patient with severe insulin allergy. Diabetes Care. 2012;35(6):e41.CrossRefPubMedPubMedCentral

18.

Kozawa J, Inoue K, Iwamoto R, Kurashiki Y, Okauchi Y, Kashine S, et al. Liraglutide is effective in type 2 diabetic patients with sustained endogenous insulin-secreting capacity. J Diabetes Investig. 2012;3(3):294–7.CrossRefPubMed

19.

Meier JJ, Menge BA, Breuer TG, Müller CA, Tannapfel A, Uhl W, et al. Functional assessment of pancreatic β-cell area in humans. Diabetes. 2009;58(7):1595–603.CrossRefPubMedPubMedCentral

20.

Usui R, Yabe D, Kuwata H, Fujiwara S, Watanabe K, Hyo T, et al. Retrospective analysis of safety and efficacy of insulin-to-liraglutide switch in Japanese type 2 diabetes: A caution against inappropriate use in patients with reduced β-cell function. J Diabetes Investig. 2013;4(6):585–94.CrossRefPubMedPubMedCentral

21.

Jendle J, Nauck MA, Matthews DR, Frid A, Hermansen K, Düring M, et al. LEAD-2 and LEAD-3 Study Groups: Weight loss with liraglutide, a once-daily human glucagon-like peptide-1 analogue for type 2 diabetes treatment as monotherapy or added to metformin, is primarily as a result of a reduction in fat tissue. Diabetes Obes Metab. 2009;11(12):1163–72.CrossRefPubMed

22.

Chen JH, Tang WH, Lee CH. Effective weight loss after treatment with a glucagon-like peptide-1 receptor agonist in a morbidly obese and diabetic patient before bariatric surgery: a case report. J Med Case Rep. 2014;8:304.CrossRefPubMedPubMedCentral

23.

Uchigata Y, Kuwata S, Tokunaga K, Eguchi Y, Takayama-Hasumi S, Miyamoto M, et al. Strong association of insulin autoimmune syndrome with HLA-DR4. Lancet. 1992;339(8790):393–4.CrossRefPubMed

24.

Eguchi Y. Scatchard analysis of insulin autoantibodies in the insulin autoimmune syndrome (Japanese). J Tokyo Wom Med Univ. 1989;59:1296–305.

25.

Hara K, Tobe K, Uchigata Y, Nakazono M, Yasuda K, Terauchi Y, et al. Antibody-mediated insulin resistance treated by cessation of insulin administration. Intern Med. 2000;39(2):143–5.CrossRefPubMed

26.

Tamura Y, Kimbara Y, Funatsuki S, Mabuchi S, Kodera R, Yoshimoto A, et al. A case of insulin antibody-induced glucose instability in an elderly woman with type 2 diabetes on hemodialysis, successfully ameliorated with liraglutide. Diabetol Int. 2013;4(1):71–5.CrossRef

27.

Hadjiyanni KA, Siminovitch JS, Drucker DJ. Glucagon-like peptide-1 receptor signaling selectively regulates murine lymphocyte proliferation and maintenance of peripheral regulatory T cells. Diabetologia. 2010;53(4):730–40.CrossRefPubMed

28.

Al-Badri MR, Azar ST. Effect of glucagon-like peptide-1 receptor agonists in patients with psoriasis. Ther Adv Endocrinol Metab. 2014;5(2):34–8.CrossRefPubMedPubMedCentral

29.

Kim SW, Won HK, Seok H, Lee BW, Jung CH, Lee WJ, et al. High prevalence of both anti-insulin and anti-insulin receptor antibodies in Korean patients with insulin autoimmune syndrome. Diabetes Res Clin Pract Nov. 2012;98(2):e12–5.CrossRef

30.

Kahn CR, Flier JS, Bar RS, Archer JA, Gorden P, Martin MM, et al. The syndromes of insulin resistance and acanthosis nigricans – insulin-receptor disorders in man. N Engl J Med. 1976;294:739–45.CrossRefPubMed

31.

Filier JS, Kahn CR, Roth J, Bar RS. Antibodies that impair insulin receptor binding in an unusual diabetic syndrome with severe insulin resistance. Science. 1975;190:63–5.CrossRef

Title: The effects of liraglutide on both hypereosinophilic insulin allergy and the characteristics of anti-insulin antibodies in type 2 diabetes mellitus: a case report
Authors: Hiroyuki Hirai
Emi Ogata
Nobuyuki Kikuchi
Teruyuki Kohno
Noritaka Machii
Koji Hasegawa
Tsuyoshi Watanabe
Hiroaki Satoh
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Journal of Medical Case Reports / Issue 1/2016
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/s13256-016-0994-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

The effects of liraglutide on both hypereosinophilic insulin allergy and the characteristics of anti-insulin antibodies in type 2 diabetes mellitus: a case report

Abstract

Background

Case presentation

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Case presentation

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

Inflammatory bowel disease mimicking granulomatosis with polyangiitis: a case report

Intravitreal luxated lens stuck on the optic disc: a case report

Amyand’s hernia with appendicitis masquerading as Fournier’s gangrene: a case report and review of the literature

Folie à Deux and its interaction with early life stress: a case report

Unusual side effect from a luteinizing hormone-releasing hormone agonist, leuprorelin, in the treatment of prostate cancer: a case report

Pulmonary embolism as a complication of an electrophysiological study: a case report