Antibody-Mediated Extreme Insulin Resistance: The Importance of Pre-Treatment Screening

Figure 2

Pre-Immunomodulatory Therapy Screening Protocol. BMI = body mass index; HbA1c = glycated hemoglobin; DKA = diabetic ketoacidosis; HHS = hyperosmolar hyperglycemic state; HIV = Human Immunodeficiency Virus; ANA = antinuclear antibodies; anti-dsDNA = anti-double stranded DNA; anti-Sm = anti Smith antibody; anti-TPO = anti-thyroid peroxidase antibody; Scl-70 antibody = anti-topoisomerase 1 antibody; SPEP = serum protein electrophoresis; UPEP = urine protein electrophoresis; CBC = complete blood count. There is no commercially available insulin receptor antibody assay in the United States of America at this time. National Institutes of Health Immunomodulatory Protocol originally detailed by Malek et al. [2]. Immunotherapy cycles consist of rituximab infusion, 2 mg/mL in 0.9% sodium chloride, 750 mg/m² body surface area (Day 1); dexamethasone 40 mg once daily by mouth (Day 1–4); and cyclophosphamide 100 mg once daily by mouth (Day 1 through remission).