I recently was tested for insulin antibodies and the test came back in the positive range. The doctor explained this can happen with injected insulin over time, even with just using human insulins like Humulin and Humalog (the only two insulins besides Apidra I have ever used).
She also said these antibodies could reduce the effectiveness of insulin. Is anyone aware of to what degree this happens, if it is a consistent effect or a sporadic one, and how to spot it when does happen? Perhaps like some of you, there are times my high blood sugar just does not seem to respond to my normal basal/bolus rates, climbing higher despite almost heroic boluses of fast-acting insulin, changing the infusion sets, insulin bottles, etc…
Finally, she told me that using Apidra would alleviate this condition to some extent, because the insulin is encapsulated in a way unlike other fast-acting insulins. So I am using Apidra now, and it does not irritate pump infusion sites nearly as much as Humalog did, so perhaps there is something to that.
It is very rare to develop insulin antibodies,but it happens and been suspected when gradually insulin dose is increased though other control parameters are stable( diet,excersie…)then we prove it by doing antibodies.Your doctor is changing the type of insulin.Hope that will be fine and not producing any more antibodies.
I researched this a while back and could only find one published paper about it. That paper suggested that levels of antibodies high enough to cause the need for extremely high insulin doses might abate after about a year. Meanwhile, in the case reported, they were using U-500 insulin until the problem cleared up.
My understanding is that any injected protein will cause some amount of antibodies to be produced. (Byetta does this too.) The problem is when there is a very strong antibody production that keeps the protein from doing its job.
I’m a big Apidra fan. Just wish my insurance didn’t make me pay full price for it. I’ve been using samples my endo gave me and it works much better for me than any other fast acting insulin (and I’ve tried them all.)
I have nothing to offer here except my thanks for teaching me something new about diabetes today. That, and to say I like Apidra and have used it since the FDA first approved it with only good results.
“It is very rare to develop insulin antibodies,” ------------ link, or proof(s) of this?
cuz in looking around, i’m finding stuff like this:
“Anti-insulin antibodies are common in people with diabetes treated with subcutaneous human insulin (HI) (1). It has been shown that up to 80% of people treated with subcutaneous insulin may develop anti-insulin antibodies (1).” http://care.diabetesjournals.org/content/25/5/876.full
Hi, I actually have been dealing with antibodies as well. It was one of the reasons why I had to come off of the Medtronic pump that I was using- I had to go back to using a long-acting and a short-acting insulin.
I have gone from 15:1 ratio to 5:1 ratio. I have used Novolog, R, Humalog and Humilin… I actually think there was one more in there too, but I can’t remember. I’ve been hearing a lot of good stuff about Symlin. My doctor has not brought up the Symlin product, but I’ve been researching it on the net and in these forums. Supposed to be an answer to some of our “antibody” problems.
My insulin antibodies yesterday were 17.9 U/mL, reference range less than 0.4 U/mL. The doc said its just more information for me, nothing really to be done about it. I’m staying on the Minimed pump, and will strongly consider trying CGMS again since variability is a built-in part of my body’s chemistry. I could never get those ISIG’s in a good range on the CGMS but I will try again. I am curious to see whether switching insulin could “trick” my body, if only for a few months.
I know this is an old thread, but I was wondering if anyone has anything new. I, took, came off the pump and onto levimir and (now) apidra to try and find something that works. I was told I have insulin antibodies (guess) since even if they did blood tests “there’s nothing we can do about the results”.
The “nothing we can do about it” is the part I just cannot believe. Does anyone have any experience with this?
We just added metformin today to try to increase my sensitivity to injected insulin…
I’m in the same boat, and it’s frustrating. I was on Met for 6 months to see if it helped, and it didn’t, I actually just stopped taking it last week.
The best you or I can do is just try to stay on top of the highly variable changes in insulin requirements… I can literally go from needing 40u one day, to 140u the next, when my activity/food/etc is all exactly the same… I have two doctors (my endo and my allergist) scratching their heads over it. Neither my CDE or my pump rep have really offered a whole lot of helpful advice.
Generally I can tell when things are starting to “get bad” lately… I get more irritation/reaction where I’m injecting (or pumping) and switching to a different insulin sometimes helps a little, but for me it seems to be a cascade effect… the more insulin I need, the worse things are, which is a giant catch-22 - it’s hard to get control without massive amounts of insulin, and that insulin itself just seems to make things worse…
Wearing a CGM helps, because I can begin to see the upward trends and compensate faster than just fingersticks alone. Eating lower carb has helped some, but I’m not taking it to extremes.
In practice, it’s still treated like most other forms of insulin resistance: increase insulin dose, try different formulations, and/or add other therapies like symlin and metformin).
anti-insulin antibodies to human insulin and analogs (regular, humalog, novalog) are very common in T1D, but produced at low levels and low affinity (they don’t bind strongly to insulin). so, they are not seen as a major problem like they were with pig and cow insulins. there really isn’t much else to do because once a B cell starts making antibodies, you’d need to swing a very large hammer at the immune system to stop them:)
yeah, you’re dealing with more than just your typical anti-insulin antibodies. if anti-histamines don’t work, desensitization can work but the trouble will be finding an allergist who will perform it.
I didn’t think about seeing an alergist… but I guess if they don’t have better answers, there’s no point. And if this metformin isn’t going to work either…grrrrr… I’ve got symlin- any luck with that?
So when you swing from 40 to 140 (it’s GREAT to hear I’m not the only one!) do you think it lasts a few days/ weeks? I always get scared to up the amounts too much because I never know when they will drop back down…
I went off the pump, but am considering just wearing the cgm for that fact (catching trends) alone. Turning off the “high glucose alarm” first, of course.
@bsc- I thought antihistamines RAISED your blood sugar anyway? I don’t need any help going in that direction, but maybe I’m wrong…?
@TomT there’s that “really isn’t much you can do” again. So should I just start saving up for dialysis? Isn’t there ANYBODY studying this?? (in the U.S.) Or where do I get a “large hammer”? Do you mean just massive doses of Insulin or…?
I really appreciate anyone who says they have this problem too… I"m so sick of hearing about 5%-7% a1c’s and being told “well just eat low carb”. I’ve been at this almost 10 years now… not eating hasn’t helped either. I can run 300 fasting… so THANK YOU for your comments- they mean alot to me!
I believe that “some” antihistamines can raise your blood sugar, but many don’t. Try benadryl, it is not listed in the prescribing information as raising blood sugar and I have used it with no effect on my levels. If you can tamper down you bodies immune reaction, you may have less of a reaction and less variation in your insulin resistance.
I just want to clarify that having anti-insulin antibodies does not always = allergy. Anti-insulin antibodies are common in insulin-dept diabetics, but allergy is rare. Allergy is usually mediated by a specific type of antibody (IgE). If you’re getting inflammation at injection sites (like Sarah), then insist on getting a blood test for anti-insulin IgG and IgE. But anti-histamines will not aid a non-allergic antibody response, so it’s important to first establish that you are, in fact, dealing with allergy. If it is, then anti-histamines and desensitization will be available options but you should discuss that with your doc.
I apologize if my ‘not much you can do’ comment offended you; I didn’t mean it that way. Unfortunately, the hammer you would need would have to destroy the cells that make the antibody, wiping out your humoral immune system and immune history in the process. These cells are not easy to stop – but nature intended it to be that way because those same cells protect you from all kinds of nasty things. It’s similar to transplantation – you can cure T1D with a pancreas or islet transplantation but the immunosuppression (currently) required does not favor that treatment in all but the most extreme cases where the risk of infection, cancer, and death is outweighed by the benefit.
I’m sure someone is researching it, but whether or not anything has come of it is a different story…
Well this is no to insulin allergy but to something a bit more common. Lily (makers of humalog) use natural rubber solids in their stoppers (perhaps they have stopped, but I doubt it). My humalog use was probably the last straw in developing a latex allergy. I switched to novolog then to apidra and my allergy issues diminished, the itching stopped. While yes you may have insulin antibodies you might have been reacting the the latex proteins that you were getting for the humalog.
not to nit-pick, but that book is 20 years old, and the references for the section that you paraphrase are from 1950 and 1979. we’ve come a long way since then:) not only are insulin preparations vastly different from 30+ years ago, but our understanding of immunology has advanced tremendously. ‘traditional’ treatments are often discarded when proven obsolete.
antihistamines don’t generically impair inflammation. they are hist receptor antagonists; they act downstream of histamine release following mast cell degranulation (which is further downstream of antibody production and binding to their Fc receptors). they act to reduce histamine-induced inflammation (the hallmark of allergic hypersensitivity) and will improve insulin absorption in the case of allergy. but they will have no effect on plasma B cells that make the antibody and will therefore have little to no impact on direct neutralization of insulin and non-allergic insulin resistance. they’re generally safe, but do make some people drowsy and can’t be taken for several days or longer before an allergy test.
while systemic glucocorticoid use could impair plasma cells, many of the common ones (prednisone, hydrocortisone) lead to insulin resistance themselves and have some broad immunosuppressive properties. those are some strong counter-indications for a diabetic. i’d be surprised if any endo would even consider it in 2010.
i also didn’t mean to suggest that both allergic and non-allergic responses can’t happen simultaneously, they can. but responsiveness of treatment will be quite different.
i’m trying to keep this as brief as possible, and apologize if it comes across in any way as confusing, condescending, or otherwise antagonistic. i’m not trying to start an argument, but trying to help clarify things so that when someone goes to their doc they can have a more informed conversation;) and you don’t have to take my word for it, ask your doc. never trust anything you read on the internet!
Tom, I’m glad that things have improved tremendously, but allergic and autoimmune reactions are not independent things. Skin reactions such as those reported by Sarah reflect an inflammation along an allergic axis that may well respond to an antihistamines. And I agree you should discuss it with your doctor.
ps. I have had great luck addressing localized reactions using Benadryl lotion.
That, and to say I like Apidra and have used it since the FDA first approved it with only good results.