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Study · Not a test of the peptide alone · 2026

1 result

Type B insulin resistance with glycemic extremes: a case report and literature review.

Ngo EMT, Rowe JM, Chillon TS, Schomburg L, Brown RJ, Tadisina S

Frontiers in endocrinology22 May 2026

PMID42255432 (opens in a new tab)PMCIDPMC13236523 (opens in a new tab)DOI10.3389/fendo.2026.1852784 (opens in a new tab)PepBankPUB-42255432
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Summary

BackgroundType B insulin resistance (TBIR) is a rare autoimmune disorder caused by immunoglobulin G (IgG) autoantibodies targeting the insulin receptor. These antibodies act as partial agonists, resulting in severe insulin resistance and hyperglycemia at high titer, and hypoglycemia at low titer. TBIR typically affects middle-aged women with autoimmune diseases but may occur in younger individuals and across diverse ethnic groups. Early recognition and timely immunosuppressive therapy are crucial for remission and prevention of metabolic complications.CaseWe report a 20-year-old Hispanic woman who presented with diabetic ketoacidosis (DKA), severe refractory hyperglycemia, and extreme insulin resistance requiring high doses of U-500 insulin. She had cachexia, acanthosis nigricans, and persistent hyperglycemia despite intravenous insulin infusion exceeding 4 units/kg/day. A detailed clinical evaluation, biochemical testing, and immunologic studies were conducted to establish the diagnosis. Laboratory findings showed elevated C-peptide and adiponectin, with positive antinuclear and anti-Smith ribonucleoprotein antibodies. Insulin receptor antibody testing confirmed TBIR. The therapeutic approach included high-dose insulin therapy, adjunctive metabolic agents such as incretin agonists (GLP1 receptor agonist semaglutide), and immunosuppressive therapy, with continuous glucose monitoring (CGM) used for dynamic glucose assessment and titration. Adjunctive therapy with metformin and low-dose semaglutide reduced daily insulin requirements from over 5,000 units to 200 units. Subsequent treatment with rituximab and azathioprine led to complete discontinuation of insulin within one week. However, the course was complicated by serum sickness-like illness and recurrent fasting hypoglycemia, which was managed with glucocorticoids and diazoxide.ConclusionThis case illustrates a rare presentation of TBIR in a young Hispanic female, initially manifesting as refractory DKA and extreme insulin resistance, followed by antibody-induced hypoglycemia, highlighting the spectrum of TBIR. This biphasic glycemic course underscores the complex immunopathophysiology of TBIR. To our knowledge, this is the first reported case describing the use of a GLP-1 receptor agonist (semaglutide) to reduce insulin requirements in TBIR prior to immunosuppressive therapy. Continuous glucose monitoring proved essential in guiding therapy and preventing severe hypoglycemia. This case emphasizes the need for early diagnosis, individualized immunosuppressive regimens, and vigilant metabolic monitoring to optimize outcomes in patients with TBIR.
CC BYText from Europe PMC. Highlighted sentences are the source of results.

Results from this study1

No result from this study comes from a test of the peptide.

Studies that did not test the peptide alone1

In this study, Semaglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. These results are not evidence about taking Semaglutide.

  1. 01HumanNot a test of Semaglutide aloneCase report or seriesEfficacy outcome

    In a young woman with type B insulin resistance, adjunctive metformin plus low-dose semaglutide reduced daily insulin requirements from over 5,000 units to 200 units.

    In plain wordsIn one young woman with type B insulin resistance, metformin plus low-dose semaglutide was followed by a large fall in daily insulin need.

    Peptide
    Semaglutide
    Outcome
    DecreaseDaily insulin requirement
    Study

    n = 1

    Outcome group
    Glycemic control · Metabolic and weight

    Measurements

    Daily insulin requirement
    200 units
    after metformin plus low-dose semaglutide

    Source sentences

    Summary
    Adjunctive therapy with metformin and low-dose semaglutide reduced daily insulin requirements from over 5,000 units to 200 units.
    1 context sentence
    Summary · context
    We report a 20-year-old Hispanic woman who presented with diabetic ketoacidosis (DKA), severe refractory hyperglycemia, and extreme insulin resistance requiring high doses of U-500 insulin.

    In this study, Semaglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Semaglutide.

AI wrote and checked these results. AI can make mistakes, so check important results against the source.

Version history

PepBank keeps every version of the data on this study. Status changes from Retraction Watch, Europe PMC and Crossref are listed with their source.

  1. Version 2Current

    11 Oct 2026, 00:04 UTC

    Study results updated

  2. Version 1

    9 Oct 2026, 03:06 UTC

    First added · source update from Europe PMC

Subjects

Terms as the source lists them.

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