A case of insulin antibody-mediated insulin resistance in type 2 diabetes treated by glucocorticoid

Salah Dhoha Ben; Yassmine Abdelkafi; Khouloud Boujelben; Hamdi Frikha; Mouna Mnif; Kacem Akid Faten Haj; Nadia Charfi; Mohamed Abid; Mouna Elleuch; Majdoub Nabila Rekik

doi:10.1530/endoabs.110.EP403

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Endocrine Abstracts (2025) 110 EP403 | DOI: 10.1530/endoabs.110.EP403

ECEESPE2025 ePoster Presentations Diabetes and Insulin (245 abstracts)

A case of insulin antibody-mediated insulin resistance in type 2 diabetes treated by glucocorticoid

Dhoha Ben Salah ¹ , Yassmine Abdelkafi ¹ , Khouloud Boujelben ¹ , Hamdi Frikha ¹ , Mouna Mnif ¹ , Faten Haj Kacem Akid ¹ , Nadia Charfi ¹ , Mohamed Abid ¹ , Mouna Elleuch ¹ & Nabila Rekik Majdoub ¹

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¹Hedi Chaker University Hospital, Endocrinology Department, Sfax, Tunisia

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Introduction: Severe insulin resistance (IR), although rare, is clinically significant as it leads to deterioration of glycemic control despite very high insulin doses. One of the rarest etiologies is autoimmunity, particularly the production of insulin autoantibodies (IAA), which can result in extreme insulin resistance and unpredictable glycemic variations.

Observation: We report the case of a 61-year-old woman with a history of type 2 diabetes treated with human insulin for 10 years. She developed insulin resistance and was admitted to our hospital. She has reported a deterioration of her glycemic control despite an increase in the dose of insulin up to 200 U/day. Clinical examination was unremarkable, with no history of drug intake. A high titer of insulin antibodies was detected in the serum (77.6%). Prednisolone was administered with a dose of 0.5 mg/kg/day for one month. The dosage was tapered by 5 mg at 15-day intervals until reaching 5 mg/day. Insulin requirement decreased by 66% and glycemic control was reached."

Discussion and Conclusion: Insulin resistance is defined as a state (of a cell, tissue, or organism) in which there is a decrease of the biological response to insulin. Clinically, it manifests as a deregulation of glycemic homeostasis. IAA-mediated IR is a rare autoimmune disorder characterized by high titers of insulin autoantibodies, leading to excessive insulin binding and sequestration, resulting in postprandial hyperglycemia and nocturnal hypoglycemia. The treatment of antibody-mediated IR is not standardized; corticosteroid therapy often gives good results. Immunosuppressive therapy, insulin analogs, and plasmapheresis have been proposed in refractory cases. Although uncommon, this condition can cause significant metabolic disturbances and increased morbidity. However, if the diagnosis is early recognized and the treatment is well-conducted, the prognosis can be improved.