Endocrinology and Metabolism

Case Reports

Two Cases of hypoglycemia in IDDM patients with insulin antibody.: G A Kim, K W Lee, M R Kim, Y J Kim, J N Jang, S K Bae, B G Son; J Korean Endocr Soc. 1996;11(2):240-246. Published online November 7, 2019

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Abstract PDF: Hirata et al. first described the association of insulin antibodies with hypoglycemia attacks and decreased glucose tolerance in a patient who had not previously received insulin injections. Since that time there have been additional reports in the Japanese literature. Insulin antibodies are present in most of the patients who received insulin for a period of time, usually exceeding six weeks. There were several reports of hypoglycemia in patients with non-insulin-dependent diabetes mellitus who had developed insulin antibody after insulin administration and also in patients with insulin dependent diabetes mellitus. It is well known that either insulin antibody to the lower affinity site or insulin receptor antibody can be a eause of hypoglycemia. Recently, we experienced two cases of hypoglycemia in patient with insulin dependent diabetes rnellitus and non- insulin- dependent diabetes mellitus who had developed insulin antibody after insulin administration. Hereby we present these cases with review of the literature.

Spontaneous Hypoglycemia due to Insulin Antibody after Insulin Treatment of Diabetic Ketoacidosis.: Jin Ook Chung, Dong Hyeok Cho, Dong Jin Chung, Min Young Chung; Endocrinol Metab. 2010;25(3):217-220. Published online September 1, 2010; DOI: https://doi.org/10.3803/EnM.2010.25.3.217

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Hypoglycemia in diabetic patients is usually caused by excessive exogenous insulin or the administration of an insulin secretagogue relative to the prevailing glucose concentration. Thus, the clinical manifestations of hypoglycemia are usually not observed in diabetic patients after either insulin or an oral hypoglycemic agent is discontinued. In contrast, diabetic ketoacidosis results from relative or absolute insulin deficiency. Although about 40% of diabetic patients who inject human insulin have insulin antibodies, these antibodies seldom significantly affect the glycemic control. It has not been reported in the literature that insulin antibody in the setting of human insulin therapy is associated with diabetic ketoacidosis and subsequent hypoglycemia. We describe here a rare case of spontaneous hypoglycemia due to insulin antibody after the improvement of diabetic ketoacidosis in a patient with type 2 diabetes mellitus and who had been treated with human insulin.

Citations

Citations to this article as recorded by

Type 1 diabetes complicated with cyclic vomiting syndrome and exogenous insulin antibody syndrome: A case report
Leiluo Geng, Xue Diao, Hao Han, Ying Lin, Wei Liang, Aimin Xu
Frontiers in Endocrinology.2022;[Epub] CrossRef
Insulin Glulisine May Cause a Disease Resembling Insulin Autoimmune Syndrome: Case Report
Maki Kawasaki, Yoichi Oikawa, Takeshi Katsuki, Yusuke Kabeya, Masuomi Tomita, Mari Okisugi, Akira Shimada
Diabetes Care.2013; 36(12): e195. CrossRef
Insulin Autoimmune Syndrome with Diabetic Ketoacidosis
Yeong Geol Jo, Young Il Kim, Su Jin Lee, Ki Won Kim, Sung Wan Chun, Yeo Joo Kim, Sang Jin Kim
Journal of Korean Diabetes.2012; 13(2): 105. CrossRef

A Case of Autoimmune Hypoglycemia due to Insulin Antibody in Patient with End Stage Renal Disease.: Ji Ye Jung, Eun Seok Kang, Beom Seok Kim, Sung Wan Chun, Yumie Rhee, Chul Woo Ahn, Bong Soo Cha, Eun Jig Lee, Sung Kil Lim, Hyun Chul Lee; J Korean Endocr Soc. 2006;21(6):536-541. Published online December 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.6.536

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Abstract PDF: Fasting hypoglycemia results from several mechanisms. Autoimmune hypoglycemia is one of the rare causes of hypoglycemia, and characterized by hyperinsulinemia, fasting hypoglycemia and the presence of autoantibodies to insulin or insulin receptor. We report here on a 64-year-old male patient with autoimmune hypoglycemia with end stage renal disease. He had no history of diabetes or insulin use. He had experienced several severe hypoglycemic events. The serum C-peptide level was 7.48 ng/mL and the insulin concentration was 115.4 micro U/mL when the fasting plasma glucose level was 88 mg/dL. The insulin to glucose ratio was 5.42, which suggested the presence of insulinoma. Yet the radiologic studies, including magnetic resonance cholangiopancreatography, endoscopic ultrasonography and selective calcium stimulated venous sampling revealed no evidence of insulinoma. The insulin autoantibody level was 62 micro U/mL. Therefore, we could diagnosis the autoimmune hypoglycemia. The hypoglycemia was treated with prednisolone and the patient recovered from this. His insulin level decreased to 21.11 micro U/mL and the insulin autoantibody level decreased to 34 micro U/mL. Hypoglycemia in the hemodialysis patients is not uncommon. One should bear in mind autoimmune hypoglycemia as one of the causes of hypoglycemia in patients with no history of diabetes.

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