Successful desensitization in type 2 diabetic patient with an insulin allergy with glargine and insulin pupm: a case report

Abstract

Introduction: Insulin allergy are rare but they can occur in patients starting insulin therapy. There are different insulin desensitization protocols where insulin is diluted and given to the patient in small doses in a period of couple of days. We are presenting case report in type 2 diabetic patient with insulin allergy, where desensitization was performed using insulin pump (Medtronic Minimed Veo) with glargine. Case presentation: A 54-year-old man with 8 years history of type 2 diabetes, BMI 27.8 kg/m2 was used metformin (2 gr) and glymeperide (4 gr). His average Hba1c was 9.2±0.3% in the last year. In a period of 1 month, different insulin preparation (NPH insulin, glargine, detemir and biphasic insulin aspart/NPH) were used, but patient developed pruritic plaques (3-8 cm) at the injection sites that persisted for several days. Allergologic testing revealed positive reactions against every insulin preparation, with smaller reaction on insulin glargine. Insulin desensitization with glargine was performed using insulin pump (Medtronic Minimed Veo), where insulin was given as basal dose of 4 hours every day in the next 2 weeks, starting with daily dose of 0.1 units and slight increase up to 16 units at day 14th. During the two weeks, there was no reaction at the infusion site. After 2 weeks, the patient continued with insulin glargine using insulin pen (Sanofi Solostar) with titration algorthm (2-4 units increase) for fasting glycaemia of 5.6 mmol/l. Hba1c decreased to 6.2% in the next 6 months with insulin dose 36 units of glargine and 2 gr of metformin. Conclusion: As reported in this case, desensitization for long acting insulin (such as glargine) can be successfully performed using insulin pump and may present an easy form of therapy that is successful within a few days.