Minocycline Attenuates Severe Hyperglycemia in Patient with Lipodystrophy

Abstract

Context: Familial partial lipodystrophy (FPL) may appear with metabolic perturbations that include acute insulin resistance and severe hyperglycemia with poor metabolic control despite extremely high doses of insulin. Objective: We report on a patient with FPL, insulin resistance, and hyperglycemia (fasting glucose >180- 200 mg/dL) on 80 units of U-500 insulin daily. Unexpectedly, the patient responded within two weeks to administration of 100 mg minocycline, a well-tolerated antibiotic with anti-inflammatory properties, achieving good glycemic control with marked reductions in insulin dosage to 15 units daily. Main outcome measurement: The patient’s blood glucose averaged 130 mg/dL in both fasting and postprandial conditions on 100 units of daily insulin, with no occurrence of hypoglycemia. Conclusion: Minocycline may improve sensitivity to insulin, even after decades of severe insulin resistance, enabling individuals with FPL to achieve control after the failure of other interventions. This improved glycemic control may help attenuate risk factors for cardiovascular and kidney disease that accompany both diabetes and FPL.