Adverse Effects of Insulin Antibodies on Postprandial Plasma Glucose and Insulin Profiles in Diabetic Patients Without Immune Insulin Resistance: Implications for Intensive Insulin Regimens

To assess the possible influence of moderate titer insulin antibodies on diabetic glycemic control, we examined insulin-antibody equilibrium binding characteristics, postprandial glucose tolerance, and plasma free-insulin profiles after subcutaneous injection of both porcine and human insulin (0.15 U/kg) in 12 patients with insulin-dependent diabetes mellitus under conditions simulating intensive insulin therapy. The patients' antibodies bound porcine and human insulin indistinguishably, and their plasma glucose and freeinsulin profiles after ingestion of a standard meal were similar with both insulins. Initial increases in plasma free-insulin levels after injection of both insulins were negatively correlated with both insulin-antibody binding (r = −.55, P < .006) and postprandial hyperglycemia (peak level r = −.56, P < .006); the latter was positively correlated with insulin-antibody binding (r = .48, P < .02). The effects of insulin antibodies on postprandial plasma free-insulin and glucose levels could be accounted for substantially by the association constant of the high-affinity insulin-antibody binding sites (K¹); patients in the highest quartile for K¹ had significantly slower initial increments in plasma free insulin (0.31 ± 0.04 vs. 0.46 ± 0.06 μU/min, P < .05) and greater postprandial hyperglycemia (peak value 237 ± 10 vs. 166 ± 12 mg/dl, P < .001) than patients in the lowest quartile. We conclude that moderate insulin-antibody titers commonly found in insulin-treated patients can slow the early increase in plasma free insulin after subcutaneous injection and that this impairs postprandial glucose tolerance; such an effect may Received for publication 22 April 1986 and accepted in revised form 18 September 1986. limit the effectiveness of intensive insulin therapy.