Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Allergic Reaction to Insulin


  1. Local
  2. Systemic
  3. Insulin–antibody mediated
    Insulin Resistance


  • Occurs in 2-3% of clients
  • Develops within the first 2 weeks of therapy
  • Approximately 90% of people with local allergy have
    spontaneous resolution within 2 months while on the same
    therapy. An additional 5% will improve within 6-12 months
  • May be associated with lipoatrophy if injection sites are not rotated
    Isolated wheal & flare
  • Develops within 30 minutes
  • Resolves within an hour
  • The late phase of a biphasic reaction is painful and erythematous. This peaks in 4-6 hours and lasts for 24 hours.
    Arthus reactions
  • Are uncommon
  • They are localized small-vessel injuries with neutrophilic infiltrates
  • Develops over 4-6 hours and peaks in 12 hours
    Delayed (tuberculinlike)
  • A nodule or “deep hive” develops in 8-12 hours and peaks in 24 hours
  • Oral or topical antihistamines
  • Switch insulin brand or type

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  • Very rare, but are more common in people with histories of atopy and/or intermittent insulin therapy
    Urticaria to anaphylaxis
  • Anti-insulin IgG and IgE levels are significantly elevated
  • Occurs immediately
  • Anaphylaxis protocol
  • Insulin desensitization program

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Insulin–antibody mediated Insulin Resistance

  • Extremely rare
  • Insulin molecule induces immunologic complications
  • Use of beef-containing insulins before the initiation resistance is usually always noted
  • Presence of these antibodies may increase insulin dose or alter insulin absorption
  • Use of steroid therapy
  • Use of U-500 insulin

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