Insulin Antibodies

General

Synonym/Acronym:
islet cell antibody, glutamic acid decarboxylase antibody.

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

Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction.

Normal Findings
(Method: Radioimmunoassay) Less than 0.02 nmol/L.

Critical Findings and Potential Interventions
N/A

Overview

(Study type: Blood collected in a red-top tube; related body system: Endocrine and immune systems.)

The onset of type 1 diabetes has been shown to correspond to the development of a number of autoantibodies. The most common anti-insulin antibody is immunoglobulin G (IgG), 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 people with diabetes using insulin. The presence of insulin antibodies has been demonstrated to be a strong predictor for development of type 1 diabetes in individuals who do not have diabetes but are genetically predisposed. For additional information regarding screening guidelines and management of diabetes, refer to the study titled “Glucose.”

Indications

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

Interfering Factors

Other Considerations:


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

Potential Medical Diagnosis: Clinical Significance of Results

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 (an adverse effect of treatment for systemic lupus erythematosus)

Decreased in

: N/A

Nursing Implications, Nursing Process, Clinical Judgement

Before the Study: Planning and Implementation


Teaching the Patient What to Expect

  • Explain that a blood sample is needed for the test.
  • Discuss how the presence of insulin antibodies may be associated with diabetes. This test can assist in the diagnosis and management of type 1 diabetes.

After the Study: Implementation & Evaluation Potential Nursing Actions


Avoiding Complications

  • Discuss how good glucose management delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy. Unmanaged diabetes can cause multiple health issues including diabetic kidney disease, amputation of limbs, and ultimately, death.
  • Discuss the advantages that attendance has in support group meetings to learn how to manage the disease process from other people with diabetes. Emphasize the importance of adhering to the recommended therapeutic regime to manage diabetes.

Treatment Considerations

  • Interventions/actions include the following: Demonstrate how to perform glucose self-check and correct self-administration of insulin or oral antihyperglycemic drugs including return demonstration. Explain the importance of reporting signs and symptoms of hypoglycemia (weakness, confusion, diaphoresis, rapid pulse) or hyperglycemia (thirst, polyuria, hunger, lethargy).

Nutritional Considerations

  • Instruct the patient in the nutritional management of diabetes. Encourage consultation with a registered dietitian who is a certified diabetes educator. A variety of dietary patterns are beneficial for people with diabetes.
  • Patients who adhere to dietary recommendations report a better general feeling of health, better weight management, better management of glucose and lipid values, and improved use of insulin. There is no “diabetic diet”; however, many meal-planning approaches with nutritional goals are endorsed by the American Diabetes Association (ADA).

Clinical Judgement

  • Consider how the emotional impact of a positive diagnosis can affect adherence with recommended lifestyle changes.

Followup Evaluation and Desired Outcomes

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