医学
门冬氨酸胰岛素
胰岛素
脱敏(药物)
术前用药
胰岛素泵
1型糖尿病
甘精胰岛素
糖尿病
基础(医学)
内科学
过敏
麻醉
内分泌学
低血糖
免疫学
受体
作者
Kristy Tian,Haur Yueh Lee,Huee Boon Lim,Yoke Ling Chan,Ai Heong Chong,Suresh Chandran,Daphne Gardner
标识
DOI:10.1016/j.aace.2021.05.004
摘要
Insulin allergy, although uncommon, poses a significant challenge in those with type 1 diabetes mellitus (T1D) as insulin replacement is a necessity. Our objective is to describe a patient in whom rapid desensitization to insulin aspart was achieved using an insulin pump.A 40-year-old woman with newly diagnosed T1D developed pruritic wheals over the abdomen after being injected with insulin glargine U-300 (Toujeo) and insulin aspart. Type 1 insulin hypersensitivity was confirmed through intradermal testing and positive insulin-specific immunoglobulin E levels.The patient underwent rapid desensitization with an insulin pump. Half the anticipated daily basal requirement was initially subcutaneously administered before initiating low-dose insulin via the pump (0.000025 units/h) and increasing the dose every 30 minutes to reach her basal requirements within 5 hours. Subsequent larger bolus insulin doses did not produce any local or anaphylactic reactions. No pretreatment with corticosteroids or antihistamines was provided.Previous protocols for insulin desensitization span over days and often involve routine premedication. The case we presented suggests that insulin desensitization can be achieved over several hours using an insulin pump. A subcutaneous basal insulin cover should be provided prior to desensitization to avoid hyperglycemia necessitating an insulin bolus. Routine premedication may not always be necessary depending on reaction severity.
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