A Rare Case of Type B Insulin Resistance Syndrome

This article presents a rare case of Type B Insulin Resistance Syndrome (TBIRS) in a 40-year-old female with systemic lupus erythematosus (SLE) and diabetes mellitus. Despite high doses of insulin, the patient experienced refractory hyperglycemia, significant weight loss, and hair loss. TBIRS is characterized by a specific autoantibody against the insulin receptor, leading to decreased insulin response. The patient was treated with high doses of insulin and immunosuppressive therapy, including methylprednisolone, cyclophosphamide, rituximab, hydroxychloroquine, and IV immunoglobulin. TBIRS is associated with SLE in 60% of cases, and the primary treatment goal is to reverse the hypercatabolic state and eliminate autoantibodies. The most common cause of mortality in TBIRS is hypoglycemia.