Unusually Elevated Serum Insulin Level in a Diabetic Patient during Recombinant Insulin Therapy

Serim Kim; Yeo-Min Yun; Mina Hur; Hee-Won Moon

doi:10.3343/lmo.2013.3.1.56

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Kim, Yun, Hur, and Moon: Unusually Elevated Serum Insulin Level in a Diabetic Patient during Recombinant Insulin Therapy

Case Discussion

Clinical Chemistry

Laboratory Medicine Online

Laboratory Medicine Online 2013; 3(1): 56-59.

Published online: 1 January 2013

DOI: https://doi.org/10.3343/lmo.2013.3.1.56

Unusually Elevated Serum Insulin Level in a Diabetic Patient during Recombinant Insulin Therapy

Serim Kim, M.D.¹, Yeo-Min Yun, M.D.², Mina Hur, M.D.², Hee-Won Moon, M.D.²

¹Hanmaem Blood Center, Gwacheon, Korea.

²Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea.

Corresponding author: Yeo-Min Yun, M.D. Department of Laboratory Medicine, Konkuk University Hospital, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea. Tel: +82-2-2030-5582, Fax: +82-2-2030-5587, ymyun@kuh.ac.kr

Received 21 August 2012 Revised 12 November 2012 Accepted 12 November 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Herein, we report a case of unusually elevated serum insulin level as a result of increased anti-insulin antibody (IA)-bound insulin after continuous subcutaneous insulin infusion therapy. Detecting free insulin (unbound IAs) levels after polyethylene glycol pre-treatment could be useful to assess functional insulin levels in diabetic patients receiving insulin therapy. The E170 insulin assay can estimate total insulin (bound IAs and free insulin) levels, but it does not measure the levels of exogenous insulin analogues.

Keywords: Insulin, Insulin antibodies, Insulin immunoassay, Insulin analogues, Cross-reactivity

Figures and Tables

Fig. 1

Structures of insulin, C-peptide, and exogenous recombinant insulin [2]. The dotted circle is the target for the recombinant human insulin analogues. The arrows indicate the antigenic determinant area (antibody recognition site).

Table 1

Laboratory data

^*We performed biochemical tests using reagents from Kyowa with the TBA 200FR Neo system (Toshiba Medical Systems Co., Ltd., Tokyo, Japan). Serum insulin, C-peptide levels, and plasma HbA_1c were determined using the E170 module from MODULAR analytics (Roche Diagnostics, Mannheim, Germany) and a HLC-723 G7 analyzer (Tosoh Corporation, Tokyo, Japan), respectively.

Abbreviation: N/A, not available.

Table 2

Cross-reactivity with recombinant human insulin analogues in the E170 insulin assay

^*The percentage of cross-reactivity was calculated as detected insulin level/given concentration ×100.

Table 3

Direct, free, and total insulin levels

Abbreviation: N/A, not available.

Notes

This article is available from http://www.labmedonline.org

References

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