Insulin Receptor Antibodies

Introduction
Type B insulin resistance is a rare cause of severe insulin resistance caused by auto-antibodies directed against the insulin receptor which prevent insulin action. Typically this causes rapidly progressive non-ketotic diabetes with extreme insulin-resistance, weight loss, diffuse acanthosis nigricans, hyperandrogenism and ovulatory dysfunction. It may arise de novo or in the context of pre-existing diabetes. Type B insulin resistance has a female preponderance and is often, though not universally, associated with other autoimmune conditions such as SLE. It may spontaneously remit, and may also be associated with severe hypoglycaemia. Detection of antibodies in serum is the basis of definitive diagnosis and can also be used to monitor therapy.

Clinical Indications
Differential Diagnosis of severe insulin resistance Detection of anti-insulin receptor antibodies permits specific immuno-modulatory treatments directed against the causative antibodies.
Monitoring treatment of type B insulin resistance

Method Information
Semi quantitative Immunoprecipitation/Western blot assay

Patient Preparation
No special requirements. Contact lab before taking sample

Sample Requirements
0.2 ml serum : Contact lab before sending.

Sample Handling
No special requirements

Interpretation
Positive antibody titre supports the diagnosis of type B insulin resistance.

Quality Assessment
None available

Centres offering this assay
Cambridge Addenbrooke’s Hospital Endocrine Laboratory

References
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 Jun;22(6):814-5.

Arioglu E, Andewelt A, Diabo C, Bell M, Taylor SI, Gorden P. Clinical course of the syndrome of autoantibodies to the insulin receptor (type B insulin resistance): a 28-year perspective. Medicine (Baltimore). 2002 Mar;81(2):87-100.

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