The immunogenicity of new insulins

Treatment with conventional insulin preparations results in appreciable insulin antibody formation in nearly all subjects. High titers of insulin antibodies are undesirable. They might induce insulin allergy and insulin resistance, and they influence metabolic regulation. Also, lipoatrophy is related to the immunogenicity of insulin preparations. Insulin antibodies are transferred from insulin-treated diabetic mothers to the fetus and contribute to the increase of free plasma insulin in the fetus, thus influencing the development of macrosomia and neonatal hypoglycemia. Therefore, the risk of insulin antibody formation should be reduced. This is possible by using purified, nonbeef insulin preparations. The risk of insulin allergy, insulin resistance, lipoatrophy, and prolonged hypoglycemia in mother and child is reduced by treating pregnant diabetic subjects with purified pork or human insulin preparations. The reduction of insulin requirement that accompanies the change from conventional insulin to purified nonbeef insulin treatment will compensate to some extent for the higher costs of new insulins.