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RE: [IPk] Pump v's Lantus MDI - the 3rd way?

Hi Elizabeth

Not sure if this info fits your needs...

The development of low levels of antibodies to exogenous insulin is an 
expected consequence of insulin treatment in diabetes mellitus. In some 
cases they may lead to higher post-prandial glucose levels and increased 
risk of delayed hypoglycaemia. Very rarely this condition may cause extreme 
insulin resistance leading to very high daily insulin requirements. Immune 
mediated lipodystrophy at the injection site may also occur. This incidence 
of this phenomenon has markedly decreased due to the use of human insulin 
of high purity. Treatment may include concentrated insulin, plasmapheresis 
or short-duration high-dose corticosteroids. The insulin analogue Lispro 
has been used in cases of insulin antibodies against exogenous human 
insulin (Lahtela, 1997). ( 
http://www.sydpath.stvincents.com.au/tests/InsulinAb.htm )

Given sufficiently sensitive techniques, insulin antibodies can be detected 
in any patient being treated with exogenous insulin (248).  In the vast 
majority of patients, the titer of insulin antibodies is low, and their 
presence is of no clinical significance. Very low values are seen in 
patients treated exclusively with human recombinant insulin (251). However, 
on occasion the titer of insulin antibodies in the circulation can be quite 
high and associated with dramatic resistance to the ability of exogenous 
insulin to lower plasma glucose concentrations.  This clinical situation is 
quite rare, usually occurs in insulin-treated patients with type 2 
diabetes, and the cause and effect relationships between the magnitude of 
the increase in insulin antibodies and the degree of insulin resistance is 
unclear.  There are several therapeutic approaches for treating these 
patients and a quantitative estimate of the concentration of circulating 
insulin antibodies does not appear to be of significant benefit.  ( 



At 10:10 PM 6/05/2003, you wrote:

>Louis, I think that's brilliant if it works for you. I do wonder if putting
>Novorapid in the pump would have sorted the problem - perhaps you can't
>tolerate humalog now for some reason (people have asked me about antibodies
>to exogenous insulin, but I don't know anything about it - does anyone here
>know?). Lots of people would give up their pump and go back on injections if
>they could get similar control.

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