RAPID DESENSITIZATION WITH INTRAVENOUS INSULIN IN A PATIENT WITH DIABETIC KETOACIDOSIS AND INSULIN ALLERGY

Area of Science:

• Endocrinology
• Allergy and Immunology
• Pharmacology

Background:

• Diabetic ketoacidosis (DKA) is a serious complication of diabetes requiring prompt insulin therapy.
• Patients with a history of insulin allergy present a challenge for DKA management.
• Standard DKA treatment protocols may be contraindicated in patients with documented insulin hypersensitivity.

Observation:

• A 65-year-old female with type 2 diabetes and known allergy to multiple insulin preparations presented with severe DKA.
• Intradermal skin testing confirmed hypersensitivity to human regular insulin.
• The patient required urgent management for DKA despite her insulin allergy.

Findings:

• A rapid desensitization protocol using intravenous human regular insulin was successfully implemented after pretreatment with antihistamines and corticosteroids.
• The protocol involved gradual dose escalation of insulin, starting from extremely dilute solutions.
• The patient tolerated both intravenous and subsequent subcutaneous insulin desensitization without anaphylactic reactions, achieving resolution of DKA.

Implications:

• Rapid insulin desensitization is a viable strategy for managing DKA in patients with established insulin allergy.
• This approach enables the use of essential insulin therapy, preventing life-threatening complications.
• Further research into optimized desensitization protocols for various insulin formulations is warranted.