Therapeutic plasma exchange normalizes insulin-mediated response in a child with type 1 diabetes and insulin autoimmune syndrome

Sharwood, Erin F. , Hughes, Ian P. , Pretorius, Carel J. , Trnka, Peter, Peake, Jane and Huynh, Tony (2017) Therapeutic plasma exchange normalizes insulin-mediated response in a child with type 1 diabetes and insulin autoimmune syndrome. Pediatric Diabetes, . doi:10.1111/pedi.12522


Author Sharwood, Erin F.
Hughes, Ian P.
Pretorius, Carel J.
Trnka, Peter
Peake, Jane
Huynh, Tony
Title Therapeutic plasma exchange normalizes insulin-mediated response in a child with type 1 diabetes and insulin autoimmune syndrome
Journal name Pediatric Diabetes   Check publisher's open access policy
ISSN 1399-5448
1399-543X
Publication date 2017-03-29
Sub-type Article (original research)
DOI 10.1111/pedi.12522
Open Access Status Not yet assessed
Total pages 9
Place of publication Hoboken, NJ, United States
Publisher Wiley-Blackwell Publishing
Collection year 2018
Language eng
Formatted abstract
Background: Insulin autoimmune syndrome (IAS), characterized by glycemic dysregulation and life-threatening hypoglycemia, can occur in patients with type 1 diabetes (T1D). Diagnostic confirmation is complex but important in order to ensure timely initiation of definitive therapy.

Aims: We aimed to quantitate the degree of immunoglobulin-insulin complex (IIC) formation and its effects on glycemic control in a patient with T1D and IAS compared with T1D and non-T1D controls and before and after therapeutic plasma exchange (TPE).

Materials & Methods: The prospective descriptive study was conducted between June 2015 and December 2015 in a quaternary children's hospital in Brisbane, Australia. Percent Free "Immunoreactive" Insulin (%FII) as assessed by polyethylene glycol precipitation studies and its relationship to plasma glucose and serum insulin concentration.

Results: Samples from the patient with T1D and IAS demonstrated lower mean %FII compared to T1D (23.8±2.0 vs 52.0±6.7; P<.0001) and non-T1D (23.8±2.0 vs 102.9±2.7; P<.0001) controls. This was associated with loss of glycemic predictability and frequent severe hypoglycemia. TPE increased %FII (23.8±2.0 before TPE vs 83.6±2.5 after TPE, P<.0001) and reestablished plasma glucose responsiveness to exogenous insulin.

Discussion: IAS should be considered in T1D patients with unexplained glycemic instability and hypoglycemia. The laboratory plays an integral diagnostic role.

Conclusion: TPE is an effective method for removing IICs and normalizing insulin-mediated glucose responses.
Keyword Hypoglycemia
Insulin autoimmune syndrome
Therapeutic plasma exchange
Type 1 diabetes
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
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School of Medicine Publications
 
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