Dear All
Can anyone advise regarding this case...
Many thanks
Julian
Report 4.10.07: Patient A 16 years old female.
Diagnosed type 1 diabetes mellitus in June 2006 with polyuria, polydipsia and blood sugars >20 mmol/l. No family history of note. Started on conventional premixed insulin with good control and HbA1c 7.5% and subsequently changed to basal bolus regimen. In early 2007 insulin requirements started to increase reaching about 120 units per day. Changed to insulin pump (novorapid insulin) and over last few months has cyclical requirements of insulin going from 60 units per day for up to two weeks then needing 90-120 units per day and then suddenly falls to needing no insulin with severe hypos needing dextrose infusions for up to 10 days (Weight 73 kg). The cycle then repeats itself. The higher requirements are possibly just before her period starts. Positive to GAD and coeliac (due biopsy) antibodies with high insulin antibodies negative to adrenal antibodies. Considered to have a form of Hiratas’ syndrome due to insulin auto-antibodies against the background of established type 1 diabetes. Still having hypos despite treatment with steroids and 4 plasma exchanges.
Multiple measurements of insulin. All have shown significant falls to ~20% after PEG precipitation of antibodies. Insulin auto-antibodies have become undetectable after plasma exchange. She has multiple auto-antibodies which our immunologists are currently unable to fully explain.
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