A 61-year-old woman with a 30-year H/o insulin-dependent T2DM was referred for evaluation of reactions to insulin. She had two episodes from the past 5-months. The first episode caused a burning sensation of the extremities and nausea immediately after injecting NovoRapid® insulin. The second episode resulted in a similar reaction. Still, this time there was also angioedema of the upper airway causing difficulty in breathing and hypotension, immediately after injecting Levemir® and NovoRapid® and taking metformin. There were no cofactors associated. A Skin prick test with metformin and other insulin preparations was performed on the patient. The patient sensitization to a few insulin preparations is shown in the figure.
She was interpreted with an IgE-mediated anaphylactic reaction to insulin. As a result, she was recommended to avoid insulin unless she underwent desensitization therapy in a monitored setting followed by continuous use of an insulin pump.
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