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Fig. 6.1 Assessment and investigation for type A and type B insulin resistance syndrome. SHBG = sexhormone binding globulin.

HbAlc values.5 Improvement of acanthosis nigricans was observed in some patients. Recombinant IGF-1 (100 ^g/kg twice daily) given subcutaneously to several patients with type A syndrome was associated with improvements in glycaemic control and insulin resistance.6

Conclusion

11—-J Severe IRS should be suspected in all patients with intractable hyperglycaemia despite taking large amounts of insulin (>200 units/day). A thorough history and clinical examination may reveal underlying phenotypes of severe IRS (Figure 6.1). A high serum titre of IgG anti-insulin antibody and/or anti-insulin-receptor antibody may suggest immune causes of IRS. Treatment with immunosuppressive agents (such as rituximab, prednisolone or cyclophosphamide) or human recombinant IGF-1 may be justified as a therapeutic trial in patients with intractable hyperglycaemia.

Further Reading

2 Kahn CR, Flier JS, Bar RS, Archer JA, Gorden P, Martin MM, Roth J. The syndromes of insulin resistance and acanthosis nigricans. Insulin-receptor disorders in man. N Engl J Med 1976; 294: 739-45.

3 Coll AP, Morganstein D, Jayne D, Soos MA, O'Rahilly S, Burke J. Successful treatment of Type B insulin resistance in a patient with otherwise quiescent systemic lupus erythematosus. Diabet Med 2005; 22:814-15.

4 Coll AP, Thomas S, Mufti GJ. Rituximab therapy for the type B syndrome of severe insulin resistance. N Engl J Med 2004; 350:310-11.

5 Kuzuya H, Matsuura N, Sakamoto M, Makino H, Sakamoto Y, Kadowaki T, Suzuki Y, Kobayashi M, Akazawa Y, Nomura M, et al.Trial of insulinlike growth factor I therapy for patients with extreme insulin resistance syndromes, Diabetes 1993; 42:696-705.

6 Morrow LA, O'Brien MB, Moller DE, Flier JS, Moses AC. Recombinant human insulin-like growth factor-I therapy improves glycemic control and insulin action in the type A syndrome of severe insulin resistance. J Clin Endocrinol Metab 1994; 79:205-10.

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