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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Immunological complications of insulin therapy have been evident since animal insulins became available for the treatment of diabetes mellitus in 1922. Insulin allergy has been particularly common, with local symptoms still occurring in approximately 5% of all patients. Insulin antibodies of high titers were observed in many patients treated with early insulin preparations containing proinsulin, C-peptide, and other peptide contaminants. Immunoglobulin G-insulin antibodies of very high levels can lead to immune-mediated insulin resistance, which is now extremely rare because of the widespread use of highly purified porcine insulin and human insulin preparations. Lipoatrophy, which was reported in 10-55% of patients treated with nonpurified bovine/porcine insulin preparations, has almost disappeared in patients since the advent of exclusive human insulin treatment. In view of the wide spectrum of immune-mediated complications of insulin therapy, much attention has been directed to the reduced immunogenicity and allergenicity of highly purified porcine insulins and the more recently available recombinant and semisynthetic human insulin preparations. Insulin antibodies of the immunoglobulin G and immunoglobulin E type can develop, however, in very low titers in patients treated exclusively with human insulin. Frequency and levels of immunoglobulin G insulin antibodies are identical in patients treated either with biosynthetic or semisynthetic human insulin preparations. Allergic symptoms to human insulin are now found in < 1% of de novo-treated patients, but still may occur when human insulin is used in the insulin-allergic patient. In summary, immunological complications of insulin therapy have decreased significantly during the last two decades and are now predominantly observed in patients with interrupted insulin therapy.
Diabetes Care 1993 Dec
PMID:Immunogenicity and allergenic potential of animal and human insulins. 829 72

Insulin has been in therapeutic use for around 70 years, and the range of adverse effects associated with its use is very limited. Insulin allergy and other local cutaneous reactions, which were common with the early insulins, are now rarely seen with highly purified and biosynthetic preparations. By far the most important complication of exogenous insulin is hypoglycaemia, which affects almost all insulin-treated patients and is largely a manifestation of nonphysiological insulin regimens and routes of administration. The problem of hypoglycaemia unawareness is now being increasingly recognised, with onset of severe neuroglycopenia and coma which is not preceded by the characteristic warning symptoms associated with autonomic activation. This can occur with excessively tight glycaemic control, and this situation is usually reversible. More commonly, however, hypoglycaemia unawareness is a chronic problem which is predominantly a feature of long duration of diabetes. Although individual episodes of hypoglycaemic coma can usually be effectively treated with parenteral dextrose or glucagon, management of patients with chronic hypoglycaemia unawareness is a difficult clinical challenge, with limited therapeutic options. In the past few years, there has been concern that the use of human insulin preparations may predispose to hypoglycaemia unawareness. The evidence for and against this is discussed, although at present it is difficult to draw any absolutely firm conclusions.
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PMID:Adverse effects of exogenous insulin. Clinical features, management and prevention. 832 48

Insulin allergy in patients with diabetes mellitus on insulin treatment is a rare condition. It is suspected upon noticing immediate symptoms following insulin injections. The immediate vital implications for the patient call for prompt diagnosis and management of insulin allergy. We review current knowledge and procedures based on four diabetic patients who presented in our clinic. Insulin allergy was suspected as they showed immediate symptoms after insulin injection (urticaria, rash, angioedema, hypotension, dyspnea). A detailed allergologic work-up was performed and adequate therapy was initiated. In three of the four patients, a specific immunotherapy was started whereas in one patient a switch to oral antidiabetics was possible and consequently initiated. By standard prick testing and measurement of specific IgE antibodies, a type 1 IgE-mediated allergy was confirmed. After initiation of insulin immunotherapy, the symptoms completely resolved in two out three of patients and significantly improved in the third patient. The fourth patient was successfully switched to oral antidiabetics. Insulin allergy is a rare but severe condition that calls for immediate allergological work-up. It can be managed well in close cooperation between the diabetologist and the allergologist. Specific immunotherapy is efficient and should be considered.
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PMID:Insulin allergy: clinical manifestations and management strategies. 1818 5

Insulin allergy is a rare complication of insulin therapy. Proper management, though difficult, is critical. Here, we report the case of a patient with type 2 diabetes and insulin allergy, successfully treated with continuous subcutaneous insulin infusion (CSII).
Diabetes Res Clin Pract 2012 Aug
PMID:Severe insulin allergy successfully treated with continuous subcutaneous insulin infusion. 2260 54

Insulin allergy is rare. Both statins and angiotensin converting enzyme (ACE) inhibitors may cause local urticarial skin reactions and have been implicated to precipitate local reactions to insulin. We describe a case of a localised urticarial allergic reaction related to insulin use in a patient co-prescribed an ACE inhibitor and statin.
Diabetes Res Clin Pract 2014 Apr
PMID:Cutaneous allergy to insulin: could statins and ACE inhibitors play a role? A case report. 2453 33