Type B Insulin Resistance Syndrome: Case Report and Literature Review

Abstract:
The patient, a 28-year-old male, had been suffering from systemic lupus erythematosus for 3 years. He was presented with dry mouth, polydipsia and polyuria for 6 months, and general edema for 1 month at the Clinical Medical Center of Endocrine and Metabolic Diseases of Yunnan Province. Chronic appearance, positive acanthosis nigricans in the skin folds of neck and limbs, facial erythema rash, facial and systemic edema. Fasting blood glucose fluctuated between 19.4- 26.2mmol/L, fasting insulin >300mU/L, triglyceride 0.72mmol/L, creatinine 109.6umol/L, anti-nuclear and anti-nuclear antibody titer ⁺ 1: 320(abnormal), anti-nuclear antibody karyotype spot type, anti-SMD1 antibody positive ⁺, anti- U1-SNRn antibody positive ⁺, anti-SS-A-RO60kDA antibody positive ⁺, anti-SSA-RO52A antibody positive ⁺. Routine blood, red blood cell 2.87 * 10 ^ 12 / L (4.30-5.80 * 10 ^ 12 / L), hemoglobin 82 g/L (130-175 - g/L), platelet 372 * 10 ^ 9 / L (125-350 * 10 ^ 9 / L; Diagnosis: 1. Systemic lupus erythematosus lupus blood system involvement lupus nephritis; 2. Type B insulin-resistant diabetes; 3. Sjogren's syndrome; 4 Subclinical hypothyroidism. Immunomodulatory preparations methylprednisolone sodium succinate, Taitacept, cyclophosphamide, hydroxychloroquine, and insulin intensive treatment were used, fasting blood glucose was 20-26.2mmol/L, random blood glucose was 22-29.9mmol/L, and insulin therapy was discontinued. Patients had stable blood glucose control after changing to oral metformin sustained-release tablets, acarbose, Englipzin, ligagliptin, and the glucagon-like peptide-1 (GLP-1) analogue semaglutide. After stable blood glucose control, the hypoglycemic drugs were stopped, and the injection of semaglutide 0.25mg was continued once a week. After continuous use for 3 months, semaglutide was stopped by itself, and immunomodulators prednesone acetate, Talitacepil, cyclophosphamide and hydroxychloroquine were continued to be used, and blood glucose was controlled by 4-6mmol/L.