DÜRİYE SILA KARAGÖZ ÖZEN, ALİ UĞUR ERGİN, ORHAN DEMİR, MEHMET DERYA DEMİRAĞ
Kastamonu Medical Journal - 2022;2(4):135-137
A 29-year-old man applied to the internal medicine outpatient clinic with fatigue and high plasma glucose levels. He had type 1 Diabetes Mellitus for 10 years and was using insulin glargine U300 and insulin glulisine for treatment. His glycosylated hemoglobin level was 16.7%, and he was hospitalized. Insulin doses were calculated as 1 unite/kg /day; glulisine 3×8 unit/day and glargine U300 1×18 unit/day were ordered. Although we increased the total insulin dosage to 1,5 units/kg/day, the plasma glucose measurements did not improve. The short-acting insulin analog was switched to insulin aspart based on the fact that insulin autoantibodies might cause this situation. On aspart treatment, the patient suffered from hypoglycemia with the same doses of glulisine. The occurrence of insulin autoantibodies against glulisine was confirmed clinically. Basal insulin dose was reduced to 20 units, and aspart 3x6 units/day was enough for plasma glucose control. Hyperglycemia due to autoantibodies against analog insulins is very rare. This rare case report must be kept in mind in hyperglycemic patients with a history of longtime analog insulin treatment.
