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onset of action delayed by combining correct amounts of protamine insulin such that neither is uncomplexed antihistamines, corticosteroids, or desensitization may be required less common with new, highly purified insulins Immune insulin resistance: due to high titer circulating IgG anti-insulin antibodies Very high IgG anti-insulin antibodies require high insulin levels to compensate with highly purified insulin, now available, this reaction is very rare Injection site lipodystrophy: atrophy of subcutaneous fat rare complication due to availability of more highly concentrated insulin preparations of neutral pH Hypertrophy of subcutaneous fatty tissue is a problem if insulin is injected repeatedly at the same site -- liposuction can correct Oral hypoglycemics: Categories sulfonylureas, e extensively metabolized by the liver (90%)

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