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Type B insulin resi...
Type B insulin resistance syndrome in a patient with type 1 diabetes
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- Sjöholm, Åke (author)
- Gävle Cent Hosp, Dept Internal Med, Div Endocrinol & Diabetol, Gävle, Sweden.
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- Pereira, Maria João, 1981- (author)
- Uppsala universitet,Klinisk diabetologi och metabolism,Uppsala universitet, Klinisk diabetologi och metabolism
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- Nilsson, Thomas (author)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Uppsala universitet, Uppsala kliniska forskningscentrum (UCR)
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- Linde, Torbjörn (author)
- Uppsala universitet,Njurmedicin,Uppsala universitet, Njurmedicin
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- Katsogiannos, Petros, 1979- (author)
- Uppsala universitet,Klinisk diabetologi och metabolism,Uppsala universitet, Klinisk diabetologi och metabolism
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- Saaf, Jan (author)
- Vastmanland Hosp Koping, Dept Internal Med, Koping, Sweden.
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- Eriksson, Jan W. (author)
- Uppsala universitet,Klinisk diabetologi och metabolism,Uppsala universitet, Klinisk diabetologi och metabolism
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Gävle Cent Hosp, Dept Internal Med, Div Endocrinol & Diabetol, Gävle, Sweden Klinisk diabetologi och metabolism (creator_code:org_t)
- Bioscientifica, 2020
- 2020
- English.
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In: Endocrinology, diabetes & metabolism case reports. - : Bioscientifica. - 2052-0573. ; 2020
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Abstract
Subject headings
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- Type B insulin resistance syndrome (TBIRS) is a very rare autoimmune disorder with polyclonal autoantibodies against the insulin receptor, resulting in severe and refractory hyperglycemia. Described here is a patient who within a few months after the onset of autoimmune type 1 diabetes increased her insulin requirements more than 20-fold; despite this she had considerable difficulty maintaining a plasma glucose value of <40-60 mmol/L (720-1100 mg/dL). On suspicion of TBIRS, the patient was started on tapering dose of glucocorticoids to overcome the autoimmune insulin receptor blockade, resulting in an immediate and pronounced effect. Within days, insulin requirements decreased by 80-90% and plasma glucose stabilized around 7-8 mmol/L (126-144 mg/dL). The presence of antibodies to the insulin receptor was detected by immunoprecipitation and binding assays. After a 4-month remission on low maintenance dose prednisolone, the patient relapsed, which required repeated plasmaphereses and immune column treatments with temporarily remarkable effect. Mixed and transient results were seen with rituximab, mycophenolic acid and bortezomib, but the glycemic status remained suboptimal. Lack of compliance and recurrent infections may have contributed to this.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
Publication and Content Type
- ref (subject category)
- art (subject category)
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