Fig. 2

Clinical course. A diagrammatic representation of the treatment and clinical course of a 70-year-old man with insulin allergy. He presented 5 months before his admission with wheals, redness, and itching immediately after insulin lispro injection that progressed to an area of induration. A skin biopsy and blood tests confirmed an allergy, and after trialing different insulin regimens, we eventually introduced 0.3 mg liraglutide, discontinued the short-acting insulin, and added glimepiride and metformin. However, induration intermittently occurred after insulin glargine injections, so we eventually cross-tapered him off glargine and onto a liraglutide dose of 0.9 mg. Thereafter, his glycated hemoglobin, insulin, and eosinophil levels gradually improved. Eo eosinophil count, HbA1c glycated hemoglobin, INS insulin dose