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 0.4 Units/mL.

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 diabetics 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 Core Lab Study.”

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

  • Discuss how this test can assist in the diagnosis and management of type 1 diabetes.
  • Explain that a blood sample is needed for the test.

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.
  • Explain that unmanaged diabetes can cause multiple health issues including diabetic kidney disease, amputation of limbs, and ultimately in death.
  • Emphasize the importance of adhering to the recommended therapeutic regime to manage diabetes.
  • Discuss the advantages that attendance has in support group meetings to learn how to manage the disease process from other people with diabetes.

Treatment Considerations

  • Demonstrate how to perform glucose self-check and correct self-administer 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

  • The presence of insulin antibodies may be associated with diabetes.
  • There is no “diabetic diet”; however, many meal-planning approaches with nutritional goals are endorsed by the American Diabetes Association (ADA).
  • 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.
  • Instruct the patient in the nutritional management of diabetes.
  • Variety of dietary patterns are beneficial for people with diabetes.
  • Encourage consultation with a registered dietitian who is a certified diabetes educator.

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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