Abstract
BackgroundInsulin autoimmune syndrome (IAS) is a rare cause of hypoglycemia and is characterized by the presence of insulin autoantibodies. Patients with IAS usually complain of hypoglycemia without any previous insulin received. Glucocorticoids and immunosuppressants are used to treat IAS.Case presentationWe report four patients with diabetes who were diagnosed with non-classical IAS and describe the treatment of these patients. Moreover, the differential diagnosis with hyperinsulinism is discussed.ConclusionHigh levels of insulin autoantibodies, as well as hyperinsulinemic hypoglycemia, are found in patients with diabetes mellitus and prior exogenous insulin exposure. This situation that we classified as non-classical IAS should be attached importance to.
Highlights
Insulin autoimmune syndrome (IAS) is a rare cause of hypoglycemia and is characterized by the presence of insulin autoantibodies
We introduce a new concept of non-classical IAS and elaborate on insulin-resistant syndrome, as well as relationships with other hyperinsulinemic diseases
We review hyperinsulinemia-related diseases and discuss their distinct features compared with other cases below
Summary
Classical insulin autoimmune syndrome (IAS) is characterized by extremely high serum insulin concentrations, as well as spontaneous hypoglycemia [1]. After 15 days, blood tests showed the following: fasting plasma glucose level, 3.71 mmol/L; anti-insulin antibody, > 45.4 U/mL; and insulin concentrations were 1567.44/1493.06/1370.20/1616.43/ 1812.01 pmol/L at 0/30/60/120/180 min and C-peptide concentrations were 3.41/3.68/3.95/4.56/4.51 nmol/L at 0/ 30/60/120/180 min during the OGTT, respectively. Case 4 This patient was a 52-year-old man diagnosed with type 2 diabetes mellitus at the local hospital according to a fasting glucose test that showed a concentration of 16 mmol/L. The treatment was changed to acarbose 0.1 mg three times a day because of repeated occurrence of hypoglycemic symptoms His insulin concentrations were 1294.01/1303.77/1456.7/2057.11/ 2032.41 pmol/L at 0/30/60/120/180 min and C-peptide concentrations were 1.30/1.80/2.21/2.87/2.55 nmol/L at 0/ 30/60/120/180 min during the OGTT, respectively. Hypoglycemia syndrome did not recur (Table 1)
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