Rapid Desensitization for Insulin Allergy in Type 1 Diabetes Using an Insulin Pump: A Case Report and Literature Review

Objective: 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. Methods: A 40-ye...

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Autores principales:	Kristy Tian, MBBS, MRCP, MMed, Haur Yueh Lee, MBBS, MRCP, MMed, Huee Boon Lim, BHSN, Yoke Ling Chan, BHSN, MSN, Ai Heong Chong, BSND, Suresh Rama Chandran, MBBS, MD, MRCP, Daphne Su-Lyn Gardner, BA, BM BCh, MRCP
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	insulin allergy insulin pump desensitization type 1 diabetes Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doaj.org/article/620e587fd5a2443ca605c092e99cfb86
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spelling	oai:doaj.org-article:620e587fd5a2443ca605c092e99cfb862021-11-06T04:32:51ZRapid Desensitization for Insulin Allergy in Type 1 Diabetes Using an Insulin Pump: A Case Report and Literature Review2376-060510.1016/j.aace.2021.05.004https://doaj.org/article/620e587fd5a2443ca605c092e99cfb862021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2376060521000663https://doaj.org/toc/2376-0605Objective: 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. Methods: 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. Result: 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. Conclusion: 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.Kristy Tian, MBBS, MRCP, MMedHaur Yueh Lee, MBBS, MRCP, MMedHuee Boon Lim, BHSNYoke Ling Chan, BHSN, MSNAi Heong Chong, BSNDSuresh Rama Chandran, MBBS, MD, MRCPDaphne Su-Lyn Gardner, BA, BM BCh, MRCPElsevierarticleinsulin allergyinsulin pumpdesensitizationtype 1 diabetesDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENAACE Clinical Case Reports, Vol 7, Iss 6, Pp 346-349 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	insulin allergy insulin pump desensitization type 1 diabetes Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	insulin allergy insulin pump desensitization type 1 diabetes Diseases of the endocrine glands. Clinical endocrinology RC648-665 Kristy Tian, MBBS, MRCP, MMed Haur Yueh Lee, MBBS, MRCP, MMed Huee Boon Lim, BHSN Yoke Ling Chan, BHSN, MSN Ai Heong Chong, BSND Suresh Rama Chandran, MBBS, MD, MRCP Daphne Su-Lyn Gardner, BA, BM BCh, MRCP Rapid Desensitization for Insulin Allergy in Type 1 Diabetes Using an Insulin Pump: A Case Report and Literature Review
description	Objective: 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. Methods: 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. Result: 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. Conclusion: 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.
format	article
author	Kristy Tian, MBBS, MRCP, MMed Haur Yueh Lee, MBBS, MRCP, MMed Huee Boon Lim, BHSN Yoke Ling Chan, BHSN, MSN Ai Heong Chong, BSND Suresh Rama Chandran, MBBS, MD, MRCP Daphne Su-Lyn Gardner, BA, BM BCh, MRCP
author_facet	Kristy Tian, MBBS, MRCP, MMed Haur Yueh Lee, MBBS, MRCP, MMed Huee Boon Lim, BHSN Yoke Ling Chan, BHSN, MSN Ai Heong Chong, BSND Suresh Rama Chandran, MBBS, MD, MRCP Daphne Su-Lyn Gardner, BA, BM BCh, MRCP
author_sort	Kristy Tian, MBBS, MRCP, MMed
title	Rapid Desensitization for Insulin Allergy in Type 1 Diabetes Using an Insulin Pump: A Case Report and Literature Review
title_short	Rapid Desensitization for Insulin Allergy in Type 1 Diabetes Using an Insulin Pump: A Case Report and Literature Review
title_full	Rapid Desensitization for Insulin Allergy in Type 1 Diabetes Using an Insulin Pump: A Case Report and Literature Review
title_fullStr	Rapid Desensitization for Insulin Allergy in Type 1 Diabetes Using an Insulin Pump: A Case Report and Literature Review
title_full_unstemmed	Rapid Desensitization for Insulin Allergy in Type 1 Diabetes Using an Insulin Pump: A Case Report and Literature Review
title_sort	rapid desensitization for insulin allergy in type 1 diabetes using an insulin pump: a case report and literature review
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/620e587fd5a2443ca605c092e99cfb86
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Rapid Desensitization for Insulin Allergy in Type 1 Diabetes Using an Insulin Pump: A Case Report and Literature Review

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