qr code font in excel B Immunopathology of Insulin Therapy in Objective-C

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B Immunopathology of Insulin Therapy
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At least five molecular classes of insulin antibodies are produced during the course of insulin therapy in diabetes, including IgA, IgD, IgE, IgG, and IgM With the increased therapeutic use of purified pork and especially human insulin, the various
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significantly to the risk of both microvascular and macrovascular complications in diabetic patients
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immunopathologic syndromes such as insulin allergy, immune insulin resistance, and lipoatrophy have become quite rare since the titers and avidity of these induced antibodies are generally quite low 1 Insulin allergy Insulin allergy, or immediate-type hypersensitivity, is a rare condition in which local or systemic urticaria is due to histamine release from tissue mast cells sensitized by adherence of anti-insulin IgE antibodies In severe cases, anaphylaxis results When only human insulin has been used from the onset of insulin therapy, insulin allergy is exceedingly rare Antihistamines, corticosteroids, and even desensitization may be required, especially for systemic hypersensitivity There have been case reports of successful use of insulin lispro in those rare patients who have a generalized allergy to human insulin or insulin resistance due to a high titer of insulin antibodies 2 Immune insulin resistance Most insulin-treated patients develop a low titer of circulating IgG anti-insulin antibodies that neutralize to a small extent the action of insulin With the old animal insulins, a high titer of circulating antibodies sometimes developed, resulting in extremely high insulin requirements often more than 200 units daily This is now rarely seen with the switch to highly purified pork or human insulins and has not been reported with the analogs
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1 Diabetic cataracts Premature cataracts occur in diabetic patients and seem to correlate with both the duration of diabetes and the severity of chronic hyperglycemia Nonenzymatic glycosylation of lens protein is twice as high in diabetic patients as in age-matched nondiabetic persons and may contribute to the premature occurrence of cataracts 2 Diabetic retinopathy Three main categories exist: background, or simple, retinopathy, consisting of microaneurysms, hemorrhages, exudates, and retinal edema; preproliferative retinopathy with arteriolar ischemia manifested as cotton-wool spots (small infarcted areas of retina); and proliferative, or malignant, retinopathy, consisting of newly formed vessels Proliferative retinopathy is a leading cause of blindness in the United States, particularly since it increases the risk of retinal detachment Vision-threatening retinopathy virtually never appears in type 1 patients in the first 3 5 years of diabetes or before puberty Up to 20% of patients with type 2 diabetes have retinopathy at the time of diagnosis Annual consultation with an ophthalmologist should be arranged for patients who have had type 1 diabetes for more than 3 5 years and for all patients with type 2 diabetes, because many were probably diabetic for an extensive period of time before diagnosis Patients with any macular edema, severe nonproliferative retinopathy, or any proliferative retinopathy require the care of an ophthalmologist Extensive scatter xenon or argon photocoagulation and focal treatment of new vessels reduce severe visual loss in those cases in which proliferative retinopathy is associated with recent vitreous hemorrhages or in which extensive new vessels are located on or near the optic disk Macular edema, which is more common than proliferative retinopathy in patients with type 2 diabetes (up to 20% prevalence), has a guarded prognosis, but it has also responded to scatter therapy with improvement in visual acuity if detected early Injection of bevacizumab (Avastin), an anti-vascular endothelial growth factor (anti-VEGF), into the eye has been shown to stop the growth of the new blood vessels in diabetic eye disease Avoiding tobacco use and correction of associated hypertension are important therapeutic measures in the management of diabetic retinopathy There is no contraindication to using aspirin in patients with proliferative retinopathy 3 Glaucoma Glaucoma occurs in approximately 6% of persons with diabetes It is responsive to the usual therapy for open-angle disease Neovascularization of the iris in diabetics can predispose to closed-angle glaucoma, but this is relatively uncommon except after cataract extraction, when growth of new vessels has been known to progress rapidly, involving the angle of the iris and obstructing outflow
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