Type B insulin resistance with glycemic extremes: a case report and literature review
Abstract
Background: Type B insulin resistance (TBIR) is a rare autoimmune disorder caused by immunoglobulin G (IgG) autoantibodies targeting the insulin receptor. These antibodies act as partial agonists, resulting in severe insulin resistance and hyperglycemia at high titer, and hypoglycemia at low titer. TBIR typically affects middle-aged women with autoimmune diseases but may occur in younger individuals and across diverse ethnic groups. Early recognition and timely immunosuppressive therapy are crucial for remission and prevention of metabolic complications.
Case: We report a 20-year-old Hispanic woman who presented with diabetic ketoacidosis (DKA), severe refractory hyperglycemia, and extreme insulin resistance requiring high doses of U-500 insulin. She had cachexia, acanthosis nigricans, and persistent hyperglycemia despite intravenous insulin infusion exceeding 4 units/kg/day. A detailed clinical evaluation, biochemical testing, and immunologic studies were conducted to establish the diagnosis. Laboratory findings showed elevated C-peptide and adiponectin, with positive antinuclear and anti-Smith ribonucleoprotein antibodies. Insulin receptor antibody testing confirmed TBIR. The therapeutic approach included high-dose insulin therapy, adjunctive metabolic agents such as incretin agonists (GLP1 receptor agonist semaglutide), and immunosuppressive therapy, with continuous glucose monitoring (CGM) used for dynamic glucose assessment and titration. Adjunctive therapy with…
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