Abstract

Background: With the introduction of recombinant formulations insulin allergy is rare, occurring in less than 1% of patients treated with insulin. However, it is a serious situation requiring immediate attention, both due to the hypersensitivity reaction and severe life threatening glucose disequilibrium.
Case presentation: A case of a 68-year-old male known diabetic for 35 years noticed some generalized itching, accompanied with maculopapular, mixed vasculitic and bullous lesions. Humalog Mix50/50 was stopped and patient was started on different combinations but to no avail. Before insulin desensitization a trial of degludec was given. Fortunately, the patient tolerated degludec and vildagliptin, and sugars came under control.
Conclusion: This combination of multi-hexamer-forming ultra-long-acting insulin plus a DPP4 inhibitor vildagliptin could be an effective combination in controlling blood sugars in patients who have severe allergy to multiple drugs including oral hypoglycemic agents and various insulin preparations.

Key words: Insulin, allergy, Combination therapy, degludec, vildagliptin, case report