FRI631 Insulin Antibody Mediated Extremely Insulin Resistant In Pregnancy

Disclosure: Z. Liu: None. D. James: None. S. Dagogo-Jack: None. Background: Insulin antibodies can rarely complicate diabetes management during pregnancy. Here, we report a patient with extreme insulin resistance during pregnancy associated with positive insulin antibodies. Clinical Case: A 40-year-old primigravida with Type 2 Diabetes (T2DM) was admitted at week 32 for uncontrolled Hypertension (HTN) and extremely high insulin requirement. T2DM was diagnosed 8 years ago and treated with basal insulin 50 units/d, dulaglutide, metformin, and glimepiride. Her HbA1c was 14% one month prior to pregnancy. During pregnancy, patient’s regimen was changed to basal bolus insulin, and oral agents were discontinued. Total daily insulin dose average 740 units (5.6 units/kg/day) at week 32. Patient’s weight was 112 kg at the beginning of pregnancy, increasing to 131 kg in the third trimester. On the high insulin regimen, her HbA1c was 5.6% at week 32. Due to the extreme insulin requirement (indicative of severe insulin resistance), we ordered insulin antibody (IAA), which came back positive at 15 µU/ml (NR <5 µU/ml). Diabetes control remained suboptimal, with frequent post-prandial hyperglycemia followed by hypoglycemia during hospitalization. Insulin regimen was optimized using U-500 in divided doses, starting with 112 units tid. At 34 weeks (hospital day 14), patient underwent cesarean section with delivery of a viable infant (weight 1450 grams, Apgar score 5 and 9 at 1 and 5 minutes). Shortly after delivery, the patient’s insulin requirement plummeted to 62 units daily and she was successfully discharged home. Diabetes control has been stable, with HbA1c ranging between 5.7% and 7% one year after delivery on total insulin dose of 60 units or less per day. Attempts to schedule patient for repeat antibody testing were unsuccessful. Conclusion: Despite the lack of data on repeat antibody testing, this is a compelling case of pregnancy associated extreme insulin resistance likely induced by insulin antibodies. Our conclusion is supported by the dramatic decrease in insulin requirement following postpartum. Presentation: Friday, June 16, 2023