Case Report

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

Table 1

Case reports of antibody-mediated insulin resistance

Age, sex (years, M/F)Race/ethnicityAcanthosis nigricansTriglyceride (mg/dL)HbA1c (%) [mmol/mol]C-peptide (ng/mL)Adiponectin (mcg/mL)Insulin antibody titerInsulin receptor antibodyMaximum documented insulin requirementAssociated rheumatologic/ malignancy diagnosis

Our case56, MHispanicN8512.4 [112]318Elevated2526 U/day
Malek et al, Case B-30 [2]20, FBlackY4211.9 [107]54.4Y18000 U/dayMixed connective tissue disorder
Malek et al, Case B-33 [2]50, FBlack689 [75]21.3Y1300 U/daySystemic lupus erythematosus
Malek et al, Case B-34 [2]62, MBlack369.2 [77]12.5Y1250 U/daySystemic lupus erythematosus
Malek et al, Case B-35 [2]17, FBlackY416.8 [51]8.3Y0 U/day
Malek et al, Case B-36 [2]64, MCanadian10211.7 [104]15.2Y1800 U/daySystemic lupus erythematosus
Malek et al, Case B-37 [2]58, FBlack9210.2 [88]24.8Y7000 U/day
Malek et al, Case B-38 [2]21, FBlack4113.5 [124]43.4Y750 U/day
Kim et al, Case 1 [4]63, MBlackN529.6 [81]4.223Borderline elevatedY21000 U/day
Kim et al, Case 2 [4]61, FJamaicanY3915.5 [146]3.0329Y11650 U/day
Kim et al, Case 3 [4]60, MBlackN10310.8 [95]1.7516ElevatedN1500 U/day
Liminet et al. [5]83, MN11–12 [97–108]3.0ElevatedN100 U/hrLymphocytic lymphoma
Mizuhashi et al. [6]62, M10.4 [90]ElevatedPulmonary adenocarcinoma
Takaya et al. [7]66, M11.9 [107]5.24ElevatedN>150 U/day
Greenfield et al. [8]68, FWhiteN44212.4 [112]0.981.7ElevatedN>300 U/day
Lahtela et al. [9]27, M12.6 [114]0Elevated360 U/day
Rhie et al, Case 1 [10]71, MWhiteElevatedN440 U/dayWaldenstrom macroglobulinemia
Rhie et al, Case 2 [10]69, MElevatedN2050 U/dayMultiple myeloma
Segal et al. [11]12, MWhite12.5 [113]0Elevated6000 U/day
Willard et al. [12]39, FNigerianY7212 [108]8.569Y>1000 U/daySystemic lupus erythematosus

Y = yes; N = no; Malek et al. [2] mentions 7 additional cases that are not included in this table given paucity of reported data. Case B-35 uniquely with normoglycemia, but nevertheless with acanthosis nigricans, hyperinsulinemia, and positive insulin receptor antibody. Insulin antibody titer listed as “borderline elevated” given reported titer of 0.4 U/ml and listed normal reference range 0.4 U/ml.