Insulin Antibodies

Insulin Antibodies

Synonym/acronym: N/A.

Common use

To assist in the prediction, diagnosis, and management of type 1 diabetes as well as insulin resistance and insulin allergy.

Specimen

Serum (1 mL) collected in a red-top tube.

Normal findings

(Method: Radioimmunoassay) Less than 0.4 Units/mL.

Description

The onset of Type I diabetes has been shown to correspond to the development of a number of autoantibodies. The most common anti-insulin antibody is immunoglobulin (Ig) G, but IgA, IgM, IgD, and IgE antibodies also have anti-insulin properties. IgM is thought to participate in insulin resistance and IgE in insulin allergy. Increased use of human insulin instead of purified animal insulin has resulted in a significant decrease in the incidence of insulin antibody formation as a result of treatment for diabetics using insulin. The presence of insulin antibodies has been demonstrated to be a strong predictor for development of Type I diabetes in individuals who do not have diabetes but are genetically predisposed.

This procedure is contraindicated for

    N/A

Indications

  • Assist in confirming insulin resistance
  • Assist in determining if hypoglycemia is caused by insulin abuse
  • Assist in determining insulin allergy

Potential diagnosis

Increased in

  • Factitious hypoglycemia (assists in differentiating lack of response due to the presence of insulin antibodies from secretive self-administration of insulin)
  • Insulin allergy or resistance (antibodies bind to insulin and decrease amount of free insulin available for glucose metabolism)
  • Polyendocrine autoimmune syndromes
  • Steroid-induced diabetes (a side effect of treatment for systemic lupus erythematosus)

Decreased in

    N/A

Critical findings

    N/A

Interfering factors

    Recent radioactive scans or radiation can interfere with test results when radioimmunoassay is the test method.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this test can assist in the diagnosis and management of type 1 diabetes.
  • Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s endocrine and immune systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Note any recent procedures that can interfere with test results.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus). Note the last time and dose of medication taken.
  • Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
  • Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
  • Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
  • Instruct the patient to resume usual diet and medication, as directed by the HCP.
  • Nutritional Considerations: Abnormal findings may be associated with diabetes. There is no “diabetic diet”; however, many meal-planning approaches with nutritional goals are endorsed by the American Dietetic Association. Patients who adhere to dietary recommendations report a better general feeling of health, better weight management, greater control of glucose and lipid values, and improved use of insulin. Instruct the patient, as appropriate, in nutritional management of diabetes. The 2013 Guideline on Lifestyle Management to Reduce Cardiovascular Risk published by the American College of Cardiology (ACC) and the American Heart Association (AHA) in conjunction with the National Heart, Lung, and Blood Institute (NHLBI) recommends a “Mediterranean”-style diet rather than a low-fat diet. The new guideline emphasizes inclusion of vegetables, whole grains, fruits, low-fat dairy, nuts, legumes, and nontropical vegetable oils (e.g., olive, canola, peanut, sunflower, flaxseed) along with fish and lean poultry. A similar dietary pattern known as the Dietary Approaches to Stop Hypertension (DASH) diet makes additional recommendations for the reduction of dietary sodium. Both dietary styles emphasize a reduction in consumption of red meats, which are high in saturated fats and cholesterol, and other foods containing sugar, saturated fats, trans fats, and sodium. If triglycerides also are elevated, the patient should be advised to eliminate or reduce alcohol. The nutritional needs of each diabetic patient need to be determined individually (especially during pregnancy) with the appropriate HCPs, particularly professionals trained in nutrition.
  • Note that the presence of insulin antibodies may be associated with diabetes. Instruct the patient and caregiver to report signs and symptoms of hypoglycemia (weakness, confusion, diaphoresis, rapid pulse) or hyperglycemia (thirst, polyuria, hunger, lethargy).
  • Recognize anxiety related to test results, and be supportive of perceived loss of independence and fear of shortened life expectancy. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Emphasize, if indicated, that good glycemic control delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy. Educate the patient regarding access to counseling services, as appropriate. Provide contact information, if desired, for the American Diabetes Association (www.diabetes.org) or the American Heart Association (www.americanheart.org).
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. The American Diabetes Association (ADA) recommends A1C testing 4 times a year for insulin-dependent type 1 or type 2 diabetes and twice a year for non-insulin-dependent type 2 diabetes. The ADA also recommends that testing for diabetes commence at age 45 for asymptomatic individuals and continue every 3 yr in the absence of symptoms. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include C-peptide, glucose, GTT, glycated hemoglobin, and insulin.
  • Refer to the Endocrine and Immune systems tables at the end of the book for related tests by body system.
References in periodicals archive ?
In one study, inhaled insulin increased the level of insulin antibodies in the body from baseline levels of 6 to 35%.
Insulin antibodies and surreptitious use of exogenous insulin can produce inappropriately high concentrations of insulin during hypoglycemia.
1 other islet autoantibody T1DM =type 1 diabetes *= Lower in adults; ** = 60% in children; 40% at age 20 and later + = Analytically the most demanding assay; ++ = automated analysis is possible but 1AA are in low concentration; +++ = adaptable to automation # = Presently screening for islet autoimmunity in non-diabetic individuals should only be performed in the research setting & = With insulin therapy, 1AA and insulin antibodies cannot be distinguished Table 2.
One of the outcomes of inhalation insulin (oral spray and nasal spray insulin) was an increase in the level of insulin antibodies from baseline levels of 6% to 35%.
The insulin antibodies formed a soluble complex with added insulin labeled with radioactive iodine, and furthermore, when non-labeled insulin was added to this mixture it could displace the labeled insulin bound to the antibody.
There were no serious adverse events related to the use of the study drug, and also no evidence of treatment-induced insulin antibodies occurring in patients, the company said.
Oral and intranasal insulin appear to be promising approaches, since animal studies suggest that insulin delivered to the mucosa induces insulin antibodies, which in turn reduce cytotoxic T-lymphocyte production.
Insulin antibodies were in the blood of five of the 12 who developed diabetes, and islet-cell antibodies were found in nine.
However, the concentration of insulin antibodies is usually much higher than IAA.
Inhalation insulin and oral and nasal insulin sprays increase the level of insulin antibodies from baseline levels of 6% to 35%.
A striking difference between the two groups was the level of insulin antibodies, which was markedly elevated in the inhaled-insulin group, said Dr.
Later the availability of human insulin in larger quantities (3) allowed the production of guinea-pig anti-human insulin antibodies, and an antibody precipitation technique made the assay easier to use.